Part B News | Part B News

Ophthalmology, endocrinology on opposite ends of 2021 E/M pay calculations

09/09/2019

In the recent proposed physician fee schedule, CMS estimated how fee changes would affect various specialties in 2020. But CMS also ran the numbers on the proposed changes to E/M code reimbursement, and how they would affect specialties when those changes are expected to take effect in 2021. It turns out they’ll help some specialties more than others — and leave some even worse off than before.

Correct Coding Initiative version 25.3 edits

09/06/2019

by: DecisionHealth staff

The Correct Coding Initiative (CCI) version 25.3 edits, effective Oct. 1, 2019, bundle dozens of codes that will restrict a range of same-day services, including some allograft procedures.

Proposed 2020 Medicare physician fee schedule

08/27/2019

by: DecisionHealth staff

This major proposed rule addresses changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute.

Use liaisons, auto-referrals to get patients to cardiac rehab, other follow-up care

08/26/2019

by: Roy Edroso

Having trouble getting patients to do difficult follow-up therapies? Cardiac rehabilitation participation rates remain generally low in the U.S., but you can implement some methods that have been proven to raise them — and may also be applied to other rehabs as well.

Practices lob dire warnings to CMS ahead of planned cuts to cataract surgery

08/26/2019

by: Richard Scott

Many providers and medical groups are expressing dismay at the rate cuts expected to hit two frequently billed codes for cataract surgery in 2020, warning that sharp pay declines could harm patient care and break the bank, particularly in rural areas.

Prepare to expand list of who can document the record, and who must verify

08/26/2019

by: James Dresbach

You’re on pace to find significant adjustments to the medical record documentation review and verification process heading into 2020, as CMS seeks to curtail work burden associated with its reigning documentation standards.

With physician suicide risk a real threat, beef up resources, wellness programs

08/26/2019

by: Roy Edroso

Added pressure in the lives of physicians leaves them uniquely vulnerable to suicide; some extra sensitivity and outreach may reduce the risk.

For E/M, initial NPP-only visit counts — unless there’s no professional service

08/26/2019

by: Roy Edroso

Question: A new patient came in and saw our physician assistant (PA) for some lacerations. She did not see a doctor. A week later the patient returned for follow up with an M.D. For purposes of billing the E/M, is the doctor visit a new patient visit or an established patient billing?

Coming cataract fees on track to drain millions from payment stream

08/26/2019

by: Richard Scott

Practices are expecting to take a hit on cataract surgery fees in 2020 based on pay rates announced in the proposed 2020 Medicare physician fee schedule, and that could lead to a drain of hundreds of millions of dollars nationally.

Payment fluctuations create big winners, losers among most-billed services

08/19/2019

by: Richard Scott

You’ll find reason to cheer the expected payments for frequently reported codes in 2020 if you conduct a steady stream of transitional care management (TCM), X-rays and other services. You may be less enthused if your bread-and-butter encounters involve vision testing or CT scanning.

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