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As lab kickback probe widens, watch for suspicious activity at your own practice

05/23/2022

As a case against providers and health care systems accused of lab fee kickbacks spreads, make sure you have safeguards in place to keep from getting enmeshed in similar schemes. Experts advise that you install financial protections and internal review policies.

E/M level impact: More practices scored level 4s under the new guidelines

05/23/2022

by: Julia Kyles, CPC

Your practice is not an outlier if its claims for 99204 and 99214 are on the rise. Industry veterans tell Part B News that claims for level 4 visits increased after the new guidelines for office and other outpatient E/M visits (99202-99215) went into effect in 2021.

Is mental telehealth a dealbreaker? If so, refer or strengthen your approach

05/23/2022

by: Roy Edroso

Question: At our practice, the primary care providers (PCP) are aware of the mental health services we can conduct via telehealth during the COVID-19 public health emergency (PHE). But some of us worry that, between our lack of psychiatric credentials and the added difficulty of delivering these services via video or phone, we may be short-changing our patients. Should we be referring these patients to dedicated mental health providers instead?

Refer to AMA guidelines, not Medicare, for approved RTM billing

05/23/2022

by: Laura Evans CPC

Question: We have a provider who is performing knee implants that will allow him to bill for the remote therapeutic monitoring (RTM) codes (98980 and 98981). The vendor is telling us that clinical staff can perform these services based on coding information they found online, but a recent CPT Assistant seems to be saying that a physician or qualified health care practitioner (QHP) must personally perform those services and that they can’t be billed by clinical staff. I am not sure how to proceed.

OIG: N.Y. provider received $1.1M in psychotherapy overpayments

05/23/2022

by: Sarah Gould

A New York City provider received an estimated $1.1 million in Medicare overpayments for behavioral health services that did not comply with billing requirements, according to a recent Office of Inspector General (OIG) report.

Pandemic sharpened decrease in psychiatric evaluation rates

05/23/2022

by: Richard Scott

Despite their addition to the audio-only services list during the COVID-19 public health emergency (PHE), a series of psychiatric evaluation codes took a significant dip in 2020 when the pandemic suppressed claims across the board.

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