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2021 E/M changes: Same-day visits and procedures can’t have overlapping time

01/25/2021

When it’s warranted to separately report an office visit at the same encounter as a procedure, clinicians will need to carefully distinguish the two services as distinct in their documentation, according to AMA coding officials.

Rule speeds approvals for ‘breakthrough’ devices, other commercially covered services

01/25/2021

by: Roy Edroso

A new final rule will allow items and services to gain approval for Medicare reimbursement more quickly than in the past, particularly medical devices that clear a specific FDA hurdle. But the devil is in the details, and the rule’s finer points will be ironed out in sub-regulatory guidance.

You should report encounters at the ‘drive-in’ site as a face-to-face visit

01/25/2021

by: Julia Kyles, CPC

Question: We have patients who can’t take part in an audio/visual telehealth visit, which is currently allowed under the COVID-19 rules. We understand we can report telephone-only visits, but the Drug Enforcement Agency (DEA) requires a real-time, two-way, audio/visual encounter when the doctor or treating practitioner writes a prescription for a controlled substance.

If doctor dies before signing the note, bill with an explanation

01/25/2021

by: Roy Edroso

Question: One of our doctors failed to review and sign the encounter notes on some of his visits — and then, unfortunately, he passed away. Can we bill for the visits?

COVID-19 waivers will be in place until April, thanks to another PHE renewal

01/25/2021

by: Julia Kyles, CPC

Circle April 21 on your calendar. That’s the new expiration date for the declaration of the COVID-19 public health emergency (PHE) that has been in place since the determination made by HHS Secretary Alex Azar on Jan. 31, 2020.

CCM expands again, as use spreads across a wide variety of specialties

01/25/2021

by: Roy Edroso

While it may be a common perception that chronic care management (CCM) services fall entirely under the primary care umbrella, the latest Medicare data show that the series of codes (99487, 99489, 99490-99491, G0506), are under use by a broad cross-section of specialties.

How to use compensation metrics to guide MDs to the practice model you prefer

01/18/2021

by: Roy Edroso

A new AMA report on physician compensation suggests that hybrid arrangements — that is, compensation based in part on salary and in part on productivity or other factors — are becoming increasingly common. Depending on your set-up, you should consider adapting to the new normal or rejiggering your compensation plans to better align your practice and retain your docs.

COVID and RVU-based reimbursement: Adjusting the algorithms

01/18/2021

by: Roy Edroso

The COVID-19 pandemic has affected all aspects of health care, and physician compensation is no exception. That would be particularly true for physicians whose productivity payments were affected by COVID-related closures, reduced patient traffic and the switch to telemedicine.

CMS boosts conversion factor for 2021 fee schedule by 8%, RVUs stay steady

01/18/2021

by: Richard Scott

Responding to a COVID-19 omnibus bill passed in late December, CMS revised the 2021 conversion factor under the Part B fee schedule to $34.89. That marks a nearly 8% increase from the $32.41 rate that the agency had previously approved in the final 2021 Medicare physician fee schedule Dec. 1.

Under 2021 guidelines, auditors can’t penalize practices that code based on time

01/18/2021

by: Julia Kyles

Practices and billing practitioners should use the coding method that benefits the practitioner when they decide whether to code an office visit based on time or medical decision-making (MDM). Auditors should not second-guess the provider’s choice during a review.

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