Part B News
Gastro codes do well with modifier 53, but 52 has some denial traps
10/10/2022
by: Roy Edroso
The modifiers 52 (Reduced services) and 53 (Discontinued procedure) often confuse providers. While total utilization remains low – 184,489 claims with 52 in 2021 and 30,850 for 53 the same year – your personal patterns may warrant another look, particularly if your practice performs a lot of the tests and exams that make up the bulk of services tied to these claims.
Conduct regular checkups of your provider’s public claims data
10/03/2022
by: Julia Kyles, CPC
Use publicly available claims data to get a complete picture of your providers’ data, see how they stack up against their peers and identify problems before they catch an investigator’s attention.
Risk analysis initiated: Use updated assessment tool to stay safe
10/03/2022
by: Dom Nicastro
One major part of complying with HIPAA is conducting a risk assessment, and a new release from federal agencies gives you a fresh tool to perform an internal security risk assessment (SRA).
CPT Assistant says no to mixing table of risk examples, CPT E/M guidelines
10/03/2022
by: Julia Kyles, CPC
When you train staff on the next update to level-based E/M services, remind them that they can’t play mix-and-match with the new guidelines and the 1995 or 1997 Documentation Guidelines for Evaluation and Management Services.
Quarterly edits bring in new bundled services, billing caps
10/03/2022
by: Richard Scott
You’ll find several hundred new code pairs added to the auto-bundling series of National Correct Coding Initiative (NCCI) edits. The billing updates, which include medically unlikely edit (MUE) additions and revisions, take effect Oct. 1.
One obstacle for more advanced med tech adoption: Malpractice
10/03/2022
by: Roy Edroso
One critical factor in physicians’ decisions to use new medical technology is a concern that the new tech may expose the physician or practice to liability claims.
Use the OIG’s data brief on telehealth to boost your compliance efforts
09/26/2022
by: Julia Kyles, CPC
Check Medicare claims data, review the new program integrity measures for telehealth services and consider other telehealth-specific risks to avoid compliance issues for these services. Those are three ways health care attorneys say that practices can incorporate guidance from a recent report on telehealth services into their telehealth compliance efforts.
OIG to CMS and legislators: Build program integrity into any new telehealth rules
09/26/2022
by: Julia Kyles, CPC
While legislators and policy creators debate permanent changes to Medicare’s telehealth rules, the HHS Office of Inspector General (OIG) issued a call to build program integrity protections into any changes. The agency included the reminder in its Sept. 2 data brief, “Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks.”
Physicians eager to tap into tech explosion, remote monitoring poised to surge
09/26/2022
by: Roy Edroso
A new study from the AMA shows physicians growing ever more comfortable with multiple forms of health care technology. The growth of telehealth is expected, but some tools that are also gaining fast, such as remote patient monitoring (RPM), may be less expected. Perhaps the biggest growth stock of all, though, is in the non-clinical area of price transparency and related data tools.
Congress debating path to flatten expected provider payment cuts
09/26/2022
by: Roy Edroso
Heads up: Congress is working up a bill to relieve providers whose reimbursement is set to take a sharp cut in 2023. But lawmakers seem inclined to take a different path than they did last year.
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