Part B News
Direct Contracting model, now ACO REACH, gets caps, governance tweaked
03/07/2022
by: Roy Edroso
After facing bouts of scrutiny, the CMS Global and Professional Direct Contracting (GPDC) Model has a new name, as well as several adjustments to risk calculations, payments and other administrative details (PBN 2/28/22).
All over the map: PA staffing clusters, pay fluctuate by region
03/07/2022
by: Richard Scott
The rapid rise of physician associates (PA) has the profession poised to play an increasingly vital role in health care delivery in the coming years, and billing rules are freeing up opportunities like direct pay (PBN 2/28/22). A look at employment data shows that some states are ahead of the curve in hiring trends.
Direct pay rule creates opportunity for PAs, but states must act
02/28/2022
by: Julia Kyles, CPC
The final 2022 Medicare physician fee schedule includes a section that authorizes direct payments to physician assistants (PA), but practices don’t have to update the enrollment of PAs on staff. In addition, the rule needs to be backed by changes at the state level to make a difference to practices, alter current roles and ameliorate the continued shortage of primary care providers.
Reserve modifier FT for surgeon’s critical care unless your MAC says otherwise
02/28/2022
by: Julia Kyles, CPC
From Medicare’s first announcement that it would create a new modifier for critical care services during an unrelated procedure’s global surgical period, modifier FT has been a source of confusion. Practices in many states are still waiting for detailed, official guidance from their Medicare administrative contractors (MAC), including which provider is eligible to report it.
Turmoil over Direct Contracting model has CMS mulling changes
02/28/2022
by: Roy Edroso
Rumblings in Washington threaten CMS’ Global and Professional Direct Contracting (GPDC) model, generally known as Direct Contracting. Experts expect the program to survive the challenge, but possibly with alterations to appease stakeholders who find the current model too friendly to large non-provider organizations.
Time to reevaluate how we evaluate coding performance
02/28/2022
by: Lawrence A. Allen, MBA, CPC, CPMA, CEMA
Over the past 25 years, medical coding has grown more critical to the success of an organization’s health care revenue cycle. Qualified coding professionals continue to be in high demand, despite the proliferation of electronic health records (EHR) and associated billing systems. Given the importance of this function, evaluating coders’ performance is an essential task for revenue integrity. The question is — is it time to reevaluate how we evaluate performance?
CMS make hundreds of CCI edit fixes in mid-quarter update
02/28/2022
by: Laura Evans, CPC
CMS has posted an unscheduled mid-quarter update to its National Correct Coding Initiative (CCI) procedure-to-procedure (PTP) claims edits. The change, with a posting date of Feb. 4, 2022, comprises reissued PTP edit files for both hospitals and practitioners.
Beyond E/M: NPs, PAs regularly clock blood draws, AWVs, skin procedures
02/28/2022
by: Roy Edroso
The increased Medicare billing of the leading non-physician providers – nurse practitioners (NP) and physician associates (PA) – is buoyed by E/M claims, given that these practitioners have become a major part of patient intake in practices. But their share of procedure codes also is increasing.
Outpatient remdesivir rolls out, and practices can offer and claim for it
02/21/2022
by: Roy Edroso
The monoclonal antibody treatment Veklury (remdesivir) is now available to use beyond the hospital setting. Check your local Medicare administrative contractor (MAC) for coverage rules and be prepared to meet the administration standards if you want to offer it to your patients.
Use a prolonged service decision tree to save time selecting prolonged service codes
02/21/2022
by: Julia Kyles, CPC
Your CPT manual contains four add-on code sets that allow your practice to earn additional revenue when a face-to-face (F2F) E/M visit in the office, outpatient or facility setting requires more time than usual.
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