Part B News | Part B News

MedPAC advises 0% pay raise in 2023, spurring calls for broader reform

03/28/2022

The official Medicare watchdog is calling for flattened payment levels for Part B services in 2023, a move that would be in line with current law, but physician advocacy groups are vocal for both a positive adjustment and broader change.

Medicare sets a 104-minute minimum for critical care code 99292

03/28/2022

by: Julia Kyles, CPC

Pay close attention to Medicare’s new critical care coding rules: You’re required to meet the 74-minute maximum for the initial critical care service on a given day (99291) plus at least 30 additional minutes of critical care services to report add-on code 99292. To remain accurate, distribute a new, Medicare-specific time chart for critical care services to your coders.

Build on lessons from latest OCR Right-of-Access enforcement actions

03/28/2022

by: Matt Duffy

Providing patients with access to their medical records remains a struggle for many health care providers. To stay ahead of potentially costly compliance errors, ensure a centralized process and learn from others’ mistakes.

Last chance: Clock is ticking to file a COVID exception to MIPS

03/28/2022

by: Roy Edroso

Mark your calendar: If you’re eligible for an Extreme and Uncontrollable Circumstances (EUC) exception to MIPS reporting for 2022 and are required to apply for it — as opposed to getting it automatically — you have until the end of Thursday, March 31, to file.

Audio-only option tied to big jumps in E/M utilization

03/28/2022

by: Julia Kyles, CPC

The audio-only option that CMS cleared for certain E/M services during the COVID-19 public health emergency (PHE) was a boon for medical practices, according to a Part B News analysis of Medicare claims data. While utilization of E/M services that did not have an audio-only option fell 14% between 2019 and 2020, services that were audio-eligible faced just a 3% dip – a considerable win in an overall depressed claims era.

Prior auth still plagues practices, but CMS, lawmakers remain idled

03/21/2022

by: Roy Edroso

Despite heightened awareness of its negative impact on care, prior authorization (PA) appears to remain at least as much of a problem as ever. But some reformers are pushing at both the state and federal levels for tech fixes and so-called gold card programs to relieve the burden.

Code bundles coming in April target path and lab services

03/21/2022

by: Richard Scott

You’ll find more than 4,000 new code bundles taking hold in April, as CMS updates its National Correct Coding Initiative (CCI) automatic billing levers. Effective April 1, the bulk of the CCI version 28.1 edits involve codes found in the pathology and laboratory section of the CPT manual.

Resist the temptation to use Medicare’s risk examples for office visits

03/21/2022

by: Julia Kyles, CPC

Question: The CPT guidelines for E/M office visits (99202-99215) do not include examples of tests or treatments that are low risk or minimal risk. Our coders aren’t sure how to score risk for some encounters, so they send questions to the providers, which has had a negative impact on everyone’s productivity. Can we continue to use the examples of low and minimal risk management options from Medicare’s table of risk to code our office visits?

How to handle an undercover sting: Cooperate, and ensure it’s credible

03/21/2022

by: Roy Edroso

Question: If one of my providers is caught in an undercover “sting” by a state or federal agency, is the practice obliged to defend the provider? If the agency asks for the practice’s cooperation, are we obliged to give it? If the provider gets arrested, are we obliged to defend them?

ACO REACH tweaks help smaller group practices, promote health equity

03/21/2022

by: Roy Edroso

Experts unlimited are getting a closer look at the ACO REACH model CMS suddenly unveiled in February, and it’s looking good for ACOs who don’t have financial resources, as well as for the advancement of CMS’ health equity cause.

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