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PAs, NPs rising: Recent rules enhance stature, profile and maybe pay

12/20/2021

Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerly known as mid-levels and extenders are increasingly important to U.S. health care. For medical groups, they may cost more to employ in the years to come.

NCCI version 28.0 edits refine billing rules for 2022

12/20/2021

by: Julia Kyles, CPC

The National Correct Coding Initiative (NCCI) edits that go into effect Jan. 1, 2022, include 46,574 new procedure-to-procedure (PTP) edit pairs and 210 new medically unlikely edits (MUE).

9 steps to meet the HIPAA cybersecurity safe harbor

12/20/2021

by: Marla Durben Hirsch

The HITECH Act amendment that creates a safe harbor for practices and other covered entities that demonstrate a robust cybersecurity program is a great incentive to beef up your organization’s cybersecurity hygiene.

How to report substance-induced disorders in ICD-10-CM

12/20/2021

by: Sarah Gould

Question: Are medical conditions due to substance use, abuse and dependence reported using ICD-10-CM codes for substance-induced disorders?

E/M revenue fell for PAs, NPs in 2020, but billing shares jumped

12/20/2021

by: Richard Scott

Despite returning significantly fewer payments for a series of core E/M office visit codes in 2020, nurse practitioners (NP) and physician assistants (PA) continued to gobble up a greater share of E/M claims in comparison to their Medicare-billing peers in other specialties.

Prepare for 4 new E/M, virtual-care modifiers to facilitate claims monitoring

12/13/2021

by: Julia Kyles, CPC

Get ready to start reporting a batch of new billing modifiers, required for various E/M and telehealth services, that will take effect Jan. 1, 2022. Review the descriptors and the information that CMS has released about them and, when you determine the modifiers that your practice will use, train staff on the modifiers’ underlying policy.

Fewer fees, obstacles for Medicare diabetes program in 2022. Is it enough?

12/13/2021

by: Roy Edroso

The Medicare Diabetes Prevention Program (MDPP) has seen scant participation, so CMS announced a series of changes in the final 2022 Medicare physician fee schedule to make it easier on both suppliers and participants. But experts aren’t sure those changes are a magic bullet for the troubled service and suggest a wider revamp may be needed.

Use training, transparency to protect your practice from employee whistleblowers

12/13/2021

by: Marla Durben Hirsch

Make sure that your employees know not only the latest compliance obligations but also where to turn internally if they’re confused or concerned about them. This does more than simply reduce the risk of making a legal mistake. It also keeps employees from running to the government when they think you’re making one.

Employees want ‘curbside’ care? Be careful, and make sure it’s on the record

12/13/2021

by: Roy Edroso

Question: I work in a physician practice and sometimes I discuss my medical issues informally with one of our doctors. He seems game, but I don’t want to get him (or us!) in trouble. Should I offer to have a formal medical visit with him instead?

MDPP at utilization nadir as new flexibilities aim for a kickstart

12/13/2021

by: Roy Edroso

The COVID-19 pandemic appears to have severely hit the Medicare Diabetes Prevention Program (MDPP) in 2020, with claims dropping to less than half of what they were in 2019. The decreased volume comes despite a range of CMS flexibilities and marks another ominous sign for the underperforming program.

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