Part B News
Look to OIG audits to steer your internal audit practices
06/13/2022
by: Joe Rivet
Conducting audits is a necessary element of an effective compliance plan. The level and sophistication of how audits are conducted are crucial to an organization. If done well, audits can help prevent and detect early potential risks. The key is how to create an audit structure with precision to target risk areas.
Preventive services fell off 7% in 2020 amid COVID’s emergence
06/13/2022
by: Roy Edroso
Most of the 16 top-billed preventive service codes fell off of their usual pace of utilization in 2020, the first year of the COVID-19 pandemic that overturned many historical claims norms.
Vaccine mandate stays; check providers’ status and respond as needed
06/06/2022
by: Roy Edroso
Five months after the Supreme Court cleared the way for the federal health care employee vaccination mandate, chances for a reprieve are dwindling. To avoid possible penalties, make sure your eligible providers are either vaccinated or have undergone the proper process for exemption; also, be sure to keep your records in order.
Critical care compliance: Find solutions to 5 key challenge areas
06/06/2022
by: Julia Kyles, CPC
Medicare’s revised rules for critical care services (99291-99292) created new ways that providers can team up and treat patients. They also spurred new ways to code and bill for the work.
Admit service dogs within reason, but ‘emotional support’ doesn’t fly
06/06/2022
by: Roy Edroso
Question: I have read the Part B News story about service animals in the practice (PBN 4/9/18). Since that story was published, I have seen a lot of coverage of “emotional support” animals and wonder if shared public spaces like the doctor’s office are required to accommodate them as well.
Ensure appropriate documentation for modifier 25
06/06/2022
by: Sarah Gould, CPC
Question: What is the best way to determine if an E/M service is above and beyond the physician work normally associated with a procedure to justify the use of modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service)?
AMA announces CPT codes for Pfizer booster, Sanofi-GSK candidate vaccine
06/06/2022
by: Sarah Gould, CPC
The AMA recently announced an editorial update to the CPT code set for COVID-19 vaccines that includes new codes for Pfizer-BioNTech’s booster vaccine and Sanofi-GlaxoSmithKline’s (Sanofi-GSK) vaccine candidate.
Reporting, revenue for common in-house lab tests dipped in 2020
06/06/2022
by: Julia Kyles, CPC
The fallout from COVID-19 didn’t stop at procedures and services. In 2020, practices reported fewer low-complexity, high-volume lab tests, resulting in a loss of more than $30 million, according to Part B News analysis of Medicare Part B claims data for 2019 and 2020.
As lab kickback probe widens, watch for suspicious activity at your own practice
05/23/2022
by: Roy Edroso
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.
 
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