Part B News
NPs set to benefit from the domiciliary, home visit merger
08/15/2022
by: Julia Kyles, CPC
Nurse practitioners (NP) will find it easier to report visits in the domiciliary and home settings when the next E/M update goes into effect Jan. 1, 2023. The update will delete the code family for domiciliary, rest home and custodial care services (99324-99337) and fold the services into the home services family (99341-99350). That code family will be renamed “home or residence services.”
Watch for revised MDM, new guidelines in the ED code update
08/08/2022
by: Julia Kyles, CPC
Focus on codes 99281, 99282 and 99283 when you study the revised descriptors and guidelines for emergency department (ED) E/M visits recently released by the AMA. The end of the three-component concept — history, exam and medical decision making (MDM) — for all level-based E/M codes prompted significant changes to these codes and will go into effect Jan. 1, 2023.
Proposed ACA rule adds language, oversight roles, advances LGBTQI+ care
08/08/2022
by: Roy Edroso
HHS and its Office for Civil Rights (OCR) unveiled a new proposed rule on July 25 interpreting the civil rights protections covered by Section 1557 of the Affordable Care Act (ACA). The rule contains new sections on “gender-affirming” care, though many providers will find extra training, oversight and language services that they may be required to provide more pressing to their practices.
Speed E/M code selection with a family-to-place-of-service crosswalk
08/08/2022
by: Julia Kyles, CPC
Help your staff connect E/M visits in the nursing facility and home with the correct place of service (POS) code with an E/M-family-to-POS crosswalk.
CMS proposes to bundle pricey skin substitute products in pro fee
08/08/2022
by: Laura Evans, CPC
A year after it finalized a policy to allow carrier-priced payment in the physician office for some synthetic skin substitutes, CMS is proposing more dramatic reimbursement changes for the implants. Specifically, the agency wants to bundle payment for these often expensive wound care products into the physician’s professional payment as “incident-to” expenses starting in 2024.
Directory glitch caused patient overcharge? Under NSA, you pay, not the plan
08/08/2022
by: Roy Edroso
Question: I know the No Surprises Act (NSA) and the CMS rules that put it in practice require that provider directories be kept up to date. But I thought that was all the insurers’ responsibility. The other day I was looking at guidance from a CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) that says, among other things, “Under the No Surprises Act, providers and health care facilities must generally ... refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information.” Why is this the providers’ responsibility?
At top and bottom of 2023 fee changes, some big hits, soft landings
08/08/2022
by: Roy Edroso with additional reporting by Laura Evans
The almost 4% proposed cut to the 2023 conversion factor would, if finalized, have a powerful negative effect on many of the most-used Part B procedure and E/M codes. Factoring in changing relative value units (RVU) reveals some big winners and losers on a per-service basis.
Great unmasking? Some practices ease on masks, but experts urge caution
08/01/2022
by: Roy Edroso
After two-plus years of COVID, mask compliance appears to be weakening, even in medical practices. Experts suggest you keep an eye on regulations and weigh the specifics of your setting and patient preferences to determine your best options.
Use the preview of new and revised CPT codes to prepare for 2023
08/01/2022
by: Julia Kyles, CPC
Get an early start on 2023 with a look at the CPT codes that will be added, revised and deleted next year. Analysis of the proposed 2023 Medicare physician fee schedule reveals changes to 10 chapters in the CPT manual, in addition to the revisions to the E/M chapter.
Medicare’s proposed plans for prolonged services full of surprises
08/01/2022
by: Julia Kyles, CPC
CMS does not intend to adopt the new CPT code for prolonged services in the facility setting, such as hospital inpatient or observation (hospital) services. But, according to the 2023 Medicare physician fee schedule proposed rule, the agency’s proposed alternative contains several twists.
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