Part B News
OIG scrutiny demands scouring of CCM records as CMS assesses overpayments
08/30/2021
by: Roy Edroso
A recent HHS Office of the Inspector General (OIG) audit of selected chronic care management (CCM) claims found many instances of duplicate claims by the same provider, which suggests some practices are not paying attention to their CCM billing. Check now to see if you’re one of them, because CMS is coming for a look-see.
Stop on transgender treatment has limited effect, but future rulings await
08/30/2021
by: Roy Edroso
The latest judicial reversal of patient protections for transgender patients alarms LGBT advocates, but beyond its narrow jurisdiction it is not expected to alter patient care elsewhere regardless of the gender identity of the patient — at least not yet.
CMS lifts annual advance beneficiary notice renewal requirement
08/30/2021
by: Julia Kyles, CPC
You’ll find some good news buried in the updated guidelines for the advance beneficiary notices of non-coverage (ABN): Yearly updates for ABNs related to repeat or continuous treatments will become a thing of the past, effective Oct. 14.
Follow 5 steps to check a sales rep’s claims on a new service or device
08/30/2021
by: Julia Kyles, CPC
A sales representative tries to interest your practice’s physicians in a pain management procedure performed with his company’s latest Food & Drug Administration-approved device. He says it is covered by Medicare and most private payers and gives you information on how to bill the service. Better still, he gives you sample documentation for the procedure. What other steps should you take to make sure you can bill the service?
CMS rescinds Most Favored Nation (MFN) model
08/30/2021
by: Matt Duffy
On August 10, CMS published a proposed rule in the Federal Register to rescind the MFN Model interim final rule, which was published in the Federal Register on Nov. 27, 2020. The rule was supposed to have gone into effect Jan. 1, 2021, but it was never implemented due to a nationwide preliminary injunction issued by the U.S. District Court for the Northern District of California on Dec. 28, 2020.
Per-patient E/M payments fluctuate by state; use them for audits
08/30/2021
by: Julia Kyles, CPC
Use Medicare’s average per-patient payment for all E/M visits in your state as the starting point for your internal review of E/M claims to see how your payments compare to those of your peers in the same area.
Get granular: New ICD-10-CM guidelines place an emphasis on specificity
08/23/2021
by: Julia Kyles, CPC
Alert your clinical and coding team to the dozens of ICD-10-CM guideline updates that will go into effect Oct. 1. Changes that will impact coding are scattered through the guidelines and range from a new call for specificity to revised instructions for coding social determinants of health (SDOH).
Providers voice concern over HIPAA Privacy Rule proposals
08/23/2021
by: Dom Nicastro
HHS published public comments on its notice of proposed rulemaking on modifications (NPRM) to the HIPAA Privacy Rule on June 24, and some providers are wary of the shortened window they would have to release patients’ protected health information (PHI).
CMS will pay for booster COVID shots for the immunocompromised
08/23/2021
by: Richard Scott
On Aug. 12, the Food and Drug Administration (FDA) revised the emergency use authorizations (EUA) for the Pfizer and Moderna COVID-19 vaccines, approving booster shots for immunocompromised individuals, and CMS later announced it would cover the extra shots.
ESRD code tops list of fee winners; cardio codes lose big
08/23/2021
by: Richard Scott
You can expect big pay gains for chronic care management (CCM) codes in 2022, but that’s not the only service in line for a reimbursement surge. By strict dollar gains, the biggest winner for services in the non-facility setting is monthly end-stage renal disease service code 90954, with fees up $206 year to year.
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