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Physician regulatory burden persists; likelihood of relief spotty

12/04/2023

A new survey of health care executives finds them at least as bothered by regulatory burdens such as prior authorization and QPP/MIPS as they’ve ever been. While modest reforms are coming to prior auth, however, the status quo isn’t likely to change in the near future.

AMA’s interactive symposium session tested participants’ E/M IQ

12/04/2023

by: Julia Kyles, CPC

Attendees of the CPT & RVBRVS 2024 Symposium tested their coding know-how during an interactive E/M question and answer session. The 43-minute presentation included poll questions that allowed attendees to enter answers to five questions that were part of the main session as well as answers to several questions about the new split or shared policy.

Doc made a bad tweet? Before disciplining, consider possible legal comebacks

12/04/2023

by: Roy Edroso

Two physicians’ recent social media reactions to the Israel-Gaza conflict, and their fallout, serve as a reminder that First Amendment defenses don’t always override contract terms. But when they do, it can mean legal trouble for employers.

Primary care management surged with switch to CPT codes

12/04/2023

by: Julia Kyles, CPC

Primary care management (PCM) services, the care management service for patients with one high-risk and complex, chronic illness, experienced a massive boost the year the codes migrated from the HCPCS to the CPT code set.

Office visits: No CMS shift on split/ shared billing, prolonged visit code

11/20/2023

by: Julia Kyles, CPC

It’s official: CMS will not allow split or shared billing for E/M office visits next year. In addition, CMS will not change prolonged visit code G2212 in response to the updated descriptors for office/other outpatient visits (99202-99205 and 99212-99215).

Direct primary care remains a slow build, but big players are interested

11/20/2023

by: Roy Edroso

While interest in the direct primary care (DPC) model of patient-pay physician practice remains keen, evidence of its adoption and efficacy is elusive, suggesting the decision to switch from a traditional insurance model is a highly personal one.

CMS streamlines diabetes prevention program, adds dental, and more

11/20/2023

by: Roy Edroso

The final 2024 Medicare physician fee schedule brings a bevy of new services and modifies current policies and coverage options. Find all the latest updates to prepare for a successful 2024, with revised policies and additions below.

OIG issues Advisory Opinion No. 23-07

11/20/2023

by: HCPro staff

On October 13, the OIG published an Advisory Opinion regarding a proposed arrangement where an employer proposed to pay a bonus to its employed physicians based on net profits derived from certain procedures performed by the physicians.

CMS releases Final Decision Memo

11/20/2023

by: HCPro Staff

On October 11, CMS published a Final Decision Memo regarding the reconsideration of NCD 20.7 for Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting.

Behavioral health care management code tops E/M gainers: 2024 PFS

11/20/2023

by: Richard Scott

The conversion factor may be pulling down fees in 2024, but some codes are bucking the trend. In some instances, CMS decided to recast the relative value units (RVU) tied to non-facility payments, and fees are jumping.

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