Part B News
Federal vaccine mandate could require shot or test for nearly all health care workers
09/20/2021
by: Roy Edroso
The impact of the Biden administration’s vaccine mandate will be more apparent when rulemaking and other sub-regulatory guidance emerges, but it appears that nearly all U.S. health care workers will be required to vaccinate against COVID-19 or take regular COVID tests as a condition of employment.
CCI version 27.3 edits reverse E/M bundles, lock in more code pairs
09/20/2021
by: Julia Kyles, CPC
Mind the latest quarterly National Correct Coding Initiative (CCI) update, which includes a reversal of procedure-to-procedure (PTP) edits that involve E/M codes along with new medically unlikely edits (MUE) for a series of COVID-19 vaccination codes. The edits, released in early September, will go into effect Oct. 1.
Is it an independent interpretation or review of test results? Here’s how to tell
09/20/2021
by: Laura Evans, CPC
As practices adjust to the 2021 E/M office visit guidelines, one area of debate has continued to circulate around when it is appropriate to count an “independent interpretation” versus a review of “the result(s) of each unique test,” as the guidelines define them.
Make sure practitioners get credit for requesting a virtual consult
09/20/2021
by: Julia Kyles, CPC
Question: We are a busy family practice group and the physicians and nurse practitioners often contact specialists in our health system for treatment advice for some of our more complex patients. We know this is good patient care, but gathering records and talking to the specialists often takes a lot of time. When the practitioner sends a request on the same day as an office visit, we code the visit based on time and include that work. The problem comes when the request goes out on a different day. Is there a way to get credit for those requests?
Use 2020 telehealth report as a baseline for internal review
09/20/2021
by: Julia Kyles, CPC
The number of office E/M visits performed via telehealth spiked in April 2020, a sign that medical practices around the country took advantage of the relaxed rules for telehealth services that went into effect March 1, 2020.
Make sure practitioners get credit for requesting a virtual consult
09/20/2021
by: Julia Kyles, CPC
Question: We are a busy family practice group and the physicians and nurse practitioners often contact specialists in our health system for treatment advice for some of our more complex patients. We know this is good patient care, but gathering records and talking to the specialists often takes a lot of time. When the practitioner sends a request on the same day as an office visit, we code the visit based on time and include that work. The problem comes when the request goes out on a different day. Is there a way to get credit for those requests?
Shared Savings slump? Dip in members, more competition signal change in ACO world
09/13/2021
by: Roy Edroso
While the Shared Savings program, CMS’ premier accountable care organization (ACO) network, has been saving the government money, it’s also leaking participants — down from 561 in 2018 to 477 in 2021. While the program appears safe for the immediate future, there’s no guarantee it won’t eventually give way to other models, which means providers should keep an eye on the latest value-based trends.
First Provider Relief Fund deadline a reminder to keep tight receipts
09/13/2021
by: Roy Edroso
Lawmakers are trying to delay the first reporting deadline for the COVID-based Provider Relief Fund (PRF), currently scheduled for the end of September. Experts say you shouldn’t count on it happening. But do count on HHS auditing your payments, and document and report accordingly.
Don’t miss the revenue opportunity in a doctor’s virtual consult request
09/13/2021
by: Julia Kyles, CPC
Question: The specialists at our practice regularly perform what we call virtual consults and we’re wondering if there’s any payment for their work. Typically, a primary care physician will call or send an email asking for advice on treating one of their patients. It usually takes our doctors a few minutes to review the data the requesting doctor provides and email a reply. But some cases are complicated and include review of several test results, some research and long conversations with the requesting doctor. The patient does not come to our office and, in most cases, our physicians have never seen the patient. We know we can’t bill an office visit (99202-99215), a consult (99241-99245 or 99251-99255) or a virtual visit (G2010 or G2012). Are there any other options?
Health spending remains down 7% through first half of 2021
09/13/2021
by: Richard Scott
The financial fallout of the COVID-19 pandemic continued well into 2021, and a return to normal spending levels doesn’t have a clear timeline, according to new research.
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