Part B News
New prior authorization bill hits House, adding Medicare Advantage plans
05/24/2021
by: Roy Edroso
A new version of a bill that would mandate faster prior authorization of services by Medicare Advantage plans has been introduced in the House and appears to have a better chance of passing than its predecessors.
OCR to practices: You’re dropping the ball on risk analysis
05/24/2021
by: Marla Durben Hirsch
It’s time for your practice to assess whether and how it conducted a security risk analysis. The HHS Office for Civil Rights (OCR) has published its latest HIPAA audit industry report, and the findings aren’t pretty.
Testing codes, marked by modifier 26, bring in scores of cash for practices
05/24/2021
by: Richard Scott
Medical practices returned reams of money on leading services that they reported with modifier 26 (Professional component), including a spate of X-ray codes, tissue exams and other testing codes.
Feds seek more vaccines at practices, but delays hamper the plan
05/17/2021
by: Roy Edroso
A number of factors are keeping COVID vaccines out of most physician practices, despite an urgent need to disseminate them. But experts believe the situation will change in due course, and practices should prepare to notify patients as soon as it does.
Don’t overlook it: History and physical exam still count for office visits
05/17/2021
by: Julia Kyles, CPC
The new E/M office visit guidelines for history and physical examinations give clinicians more freedom. They also spare coders the trouble of counting points for these portions of the patient encounter. However, coders and clinicians should work together to establish the sort of documentation that will protect patients by supporting continuity of care, maintain revenue by supporting their claims and help clinicians by keeping their workload as light as possible.
HHS opens vaccine payment fund for providers stuck with exempt plans
05/17/2021
by: Roy Edroso
Having provided reimbursement programs for other COVID-related costs unpaid by patients, HHS has now set up a new initiative to make sure providers get reimbursed for vaccine administration that’s not covered by some patients’ insurance plans.
CPT errata amends E/M coding with series of technical corrections
05/17/2021
by: Laura Evans, CPC and Julia Kyles, CPC
Pay close attention to revisions and corrections to the E/M office visit guidelines that kicked in Jan. 1. The AMA has made a number of updates, and you will need to refer to the “Errata and Technical Corrections — CPT 2021” document issued on the AMA website March 9 for the freshest E/M guidance.
Hospital claims shift reveals a dip in inpatient codes, and a bigger one in denials
05/17/2021
by: Roy Edroso
In a recent five-year span, the use of inpatient codes declined at a faster rate than they had in previous years, and denial rates dropped even more quickly.
Missing payments? No easy fix for unpaid out-of-network COVID claims
05/10/2021
by: Roy Edroso
A $6 million case concerning thousands of unpaid claims for COVID-19 testing and related services suggests that if you’re refused payment for services administered to out-of-network beneficiaries, you may be up a creek, despite laws that appear to protect your interests.
Master modifier 59: Scenarios, tips that go beyond the basics
05/10/2021
by: Susan E. Garrison
Ensure that your documentation can support modifier 59, used to describe a distinct procedural service, in order to steer clear of billing snafus. Remember that you should append modifier 59 to codes to identify procedures or services that are not usually payable when reported together.
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