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Medicare trims 15 minutes from prolonged hospital visit times

03/20/2023

Your providers will find it easier to hit the required time for a prolonged inpatient or observation visit thanks to a correction to the final 2023 Medicare physician fee schedule. The update, announced today, cuts 15 minutes from the threshold times for G0316 (Prolonged inpatient or observation services by physician or other QHP).

Tough Medicare Advantage risk adjustment, audits coming; pay impact seen

03/20/2023

by: Roy Edroso

Proposed adjustments to the codes used to risk-adjust Medicare Advantage rates have stirred discontent among physician groups as well as insurers, suggesting that these groups expect lower reimbursement as a result.

When will it end? Track PHE waiver expiration, watch for updates

03/20/2023

by: Julia Kyles, CPC

The COVID-19 public health emergency (PHE) will end May 11 and with it more than a dozen waivers that were created during the emergency will disappear. However, the end of the PHE will not spell the end of every waiver.

Modifier 25 stays down in ’21, yet practices reap fee gains

03/20/2023

by: Richard Scott

Medical groups posted some big numbers in their use of modifier 25 (Significant, separately identifiable E/M service), reporting over 65 million claims and clearing $5 billion in payments in 2021, the latest year of available data. While payments grew, the usage numbers remained down from pre-COVID highs just two years earlier.

The taxman cometh: File wisely, secure the most from practice deductions

03/13/2023

by: Roy Edroso

April is tax time, and practice owners should be attentive to changes in the tax environment — including increased legal and IRS attention and a few wrinkles in the tax code that medical personnel tend to miss.

Fearing ‘telehealth cliff,’ orgs oppose DEA’s proposed time limits, in-person demands

03/13/2023

by: Julia Kyles, CPC

Unnecessary, alarming, a step backwards. These are three terms health care organizations used to describe the Drug Enforcement Administration’s (DEA) plans for telehealth when the COVID-19 public health emergency (PHE) ends.

AMA updates two data definitions, hints at changes in 2024 and beyond

03/13/2023

by: Julia Kyles, CPC

You can assign two data points when a provider orders and interprets a test, and count documents from an appropriate source toward data review. The new guidance applies to medical decision-making (MDM) for all level-based E/M visits. It was issued in the March 1 version of the errata and technical corrections for the 2023 CPT manual and released March 3. The changes are retroactive to Jan. 1.

Psychological, neuropsychological and neurobehavioral status testing codes, 2018 and 2019

03/13/2023

by: Julia Kyles, CPC

Here are the codes and consumer-friendly descriptors featured in the Benchmark of the Week. The list represents the codes that were in effect in 2018 and 2019. It is not a crosswalk.

Major code revisions did not hamper psychological testing

03/13/2023

by: Julia Kyles, CPC

Claims for psychological, neuropsychological and neurobehavioral status testing increased and denials fell after the AMA made major revisions to the code sets in 2019, according to analysis of Medicare Part B data.

Stand by until July for the next update to the NCCI

03/13/2023

by: Julia Kyles, CPC

It’s not an early April Fool’s joke: CMS won’t issue National Correct Coding Initiative (NCCI) edits in April.

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