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Cultivate Medicare prolonged service rule compliance with a decision tree

08/07/2023

Use this decision tree to illustrate Medicare’s rules for coding prolonged E/M services. Medicare created codes and rules for prolonged services performed by a physician or qualified health care professional (QHP) because it disagrees with portions of the CPT guidelines.

To boost diabetes program, CMS revamps code set, extends virtual options

08/07/2023

by: Richard Scott

Due to billing confusion, low utilization rates and patient retention challenges, CMS seeks to deliver a sleeker design behind the Medicare Diabetes Prevention Program (MDPP) in 2024. The agency plans to chop the number of HCPCS codes eligible for reporting while maintaining virtual options for patient encounters, according to the proposed 2024 Medicare physician fee schedule released July 13.

CMS to kick 19 therapy codes back to the RUC for review

08/07/2023

by: Laura Evans, CPC

In a potential windfall for therapy practices, CMS stated in the proposed 2024 Medicare physician fee schedule, released July 13, that it would consider revaluing 19 therapy codes to evaluate whether they had been misvalued during their last review five years ago.

Determine key tips for reporting SDOH in ICD-10-CM

08/07/2023

by: Savannah Schmidt

Question: What are some tips for organizations that are just starting out capturing the type of information to report social determinant of health (SDOH) diagnoses in ICD-10-CM?

Remote BPCI codes, E/M services big gainers in proposed PFS fee dollars

08/07/2023

by: Roy Edroso; data reporting by Laura Evans, CPC

Among the services for which CMS proposes to raise reimbursement by the largest percentage in CY 2024, there’s a thread of E/M codes that meet two of CMS’ recent areas of focus – remote services and bundled care.

CMS lays plans for new telehealth list structure, code update policy

07/31/2023

by: Julia Kyles, CPC

Take note of Medicare’s plan to revamp the telehealth services list and the way it makes additions, revisions and deletions to the subset of eligible codes.

CMS locks in CAA 2023 telehealth waivers

07/31/2023

by: Julia Kyles, CPC

Practices can rest assured that Medicare will implement the waiver extensions in the Consolidated Appropriations Act, 2023. The extension keeps waivers such as the originating site, the list of eligible providers and coverage of audio-only services in place until Jan. 1, 2025, says Rachel Stauffer, senior director, McDermott+Consulting, Washington, D.C.

In QPP, CMS raises bonus floor, floats new APM conversion factor

07/31/2023

by: Roy Edroso

Most participants in the Quality Payment Program (QPP) won’t see significant changes in reporting requirements in 2024, but CMS is cooking up big future reforms. Statutory requirements in the program’s seventh year will likely result in a new payment threshold for Merit-Based Incentive Payment System (MIPS) participants and a new “qualifying APM conversion factor” method, along with other changes for Advanced APM participants.

Plant knowledge for same-day prolonged services with a decision tree

07/31/2023

by: Julia Kyles, CPC

Use this decision tree when you train staff on the CPT guidelines for coding a prolonged E/M service on the same day as the face-to-face (F2F) E/M encounter.

CMS touts ‘most important’ behavioral health changes in PFS

07/31/2023

by: Roy Edroso

For years, CMS has been heralding its seriousness about expanding its behavioral health outreach. The 2024 proposed rule may be the agency’s most ambitious play yet in this regard, potentially adding tens of thousands of new providers who can perform and bill behavioral health codes, and offering providers new service categories and even a code-valuation adjustment.

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