Part B News | Part B News

Stay sharp: Feds’ health care enforcement is shifting — and expanding

05/10/2021

It’s time to reassess and update your practice’s compliance program. The government’s health care enforcement priorities are expected to shift with the new administration.

Here’s what the DOJ wants in an effective compliance program

05/10/2021

by: Marla Durben Hirsch

The HHS Office of Inspector General (OIG) has long established that a strong compliance program for physicians consists of seven elements:

New diagnosis? Try a corrected claim, but expect pushback from your MAC

05/10/2021

by: Roy Edroso

Question: We’ve had a claim denied on the basis of medical necessity because the provider’s original diagnosis was not covered. Now the provider, after further analysis, has determined that the actual issue is different from what she had originally thought and she wants to change her diagnosis and treatment. Can we resubmit the previous claim with the new diagnosis?

Modifier 59 claims return nearly $1.5 billion in Medicare payments

05/10/2021

by: Richard Scott

Mastering the use of modifiers can be lucrative business for physician practices, as the latest modifier 59 (Distinct procedural service) utilization numbers reveal. In 2019, providers pulled in nearly $1.5 billion from Medicare on thousands of codes paired with the modifier.

Medicare age drop, adding millions, on hold, but its favor grows among lawmakers

05/03/2021

by: Roy Edroso

A number of prominent Democrats, including President Joe Biden, have advocated for a drop in the Medicare eligibility age, a move that would add millions to the program. But since Biden left this proposal out of his April 28 Congressional address, there seems little chance that it will happen this year.

5 E/M FAQs: Help clinicians catch up with coders to attain consistency

05/03/2021

by: Julia Kyles, CPC

With new rules in place and edits arriving in real time, you should ensure that your clinicians are up to speed with E/M coding and documentation.

Watch 3 basic errors, frequency to beat high denial rates on diabetes training

05/03/2021

by: Roy Edroso

Medicare’s two biggest educational services for diabetic patients have dismal denial rates, and experts say that providers who bill them have to be extra attentive to documentation details to beat the spread.

E/M coding scenario: Achieving a Level 5 established visit with MDM

05/03/2021

by: Nancy Enos, FACMPE, CPC-I, CPMA, CEMC, CPC emeritus

For the first time in more than two decades, the E/M office visit code set (99202-99215) is subject to a coding and documentation overhaul. As of Jan. 1, 2021, previously vital components of code level selection — the history and exam components — no longer factor into your level of decision-making. Instead, determining a level of service will come down to one of two components: Medical decision-making (MDM) or time.

Data access expands: Be prepared to share clinical notes with patients

05/03/2021

by: Marla Durben Hirsch

Your practice should take a look at how its clinicians document patient encounters and procedures. The new interoperability rule that bars information blocking requires providers to share electronic patient health information (ePHI) with patients who request it, and that includes clinical notes.

Coverage waivers continue as PHE gains another extension

05/03/2021

by: Richard Scott

The COVID-19 public health emergency (PHE) will last at least until July 2021 after HHS Secretary Xavier Becerra declared another extension.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.