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Preventive services fell off 7% in 2020 amid COVID’s emergence

06/13/2022

Most of the 16 top-billed preventive service codes fell off of their usual pace of utilization in 2020, the first year of the COVID-19 pandemic that overturned many historical claims norms.

Vaccine mandate stays; check providers’ status and respond as needed

06/06/2022

by: Roy Edroso

Five months after the Supreme Court cleared the way for the federal health care employee vaccination mandate, chances for a reprieve are dwindling. To avoid possible penalties, make sure your eligible providers are either vaccinated or have undergone the proper process for exemption; also, be sure to keep your records in order.

Critical care compliance: Find solutions to 5 key challenge areas

06/06/2022

by: Julia Kyles, CPC

Medicare’s revised rules for critical care services (99291-99292) created new ways that providers can team up and treat patients. They also spurred new ways to code and bill for the work.

Admit service dogs within reason, but ‘emotional support’ doesn’t fly

06/06/2022

by: Roy Edroso

Question: I have read the Part B News story about service animals in the practice (PBN 4/9/18). Since that story was published, I have seen a lot of coverage of “emotional support” animals and wonder if shared public spaces like the doctor’s office are required to accommodate them as well.

Ensure appropriate documentation for modifier 25

06/06/2022

by: Sarah Gould, CPC

Question: What is the best way to determine if an E/M service is above and beyond the physician work normally associated with a procedure to justify the use of modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service)?

AMA announces CPT codes for Pfizer booster, Sanofi-GSK candidate vaccine

06/06/2022

by: Sarah Gould, CPC

The AMA recently announced an editorial update to the CPT code set for COVID-19 vaccines that includes new codes for Pfizer-BioNTech’s booster vaccine and Sanofi-GlaxoSmithKline’s (Sanofi-GSK) vaccine candidate.

Reporting, revenue for common in-house lab tests dipped in 2020

06/06/2022

by: Julia Kyles, CPC

The fallout from COVID-19 didn’t stop at procedures and services. In 2020, practices reported fewer low-complexity, high-volume lab tests, resulting in a loss of more than $30 million, according to Part B News analysis of Medicare Part B claims data for 2019 and 2020.

As lab kickback probe widens, watch for suspicious activity at your own practice

05/23/2022

by: Roy Edroso

As a case against providers and health care systems accused of lab fee kickbacks spreads, make sure you have safeguards in place to keep from getting enmeshed in similar schemes. Experts advise that you install financial protections and internal review policies.

E/M level impact: More practices scored level 4s under the new guidelines

05/23/2022

by: Julia Kyles, CPC

Your practice is not an outlier if its claims for 99204 and 99214 are on the rise. Industry veterans tell Part B News that claims for level 4 visits increased after the new guidelines for office and other outpatient E/M visits (99202-99215) went into effect in 2021.

Is mental telehealth a dealbreaker? If so, refer or strengthen your approach

05/23/2022

by: Roy Edroso

Question: At our practice, the primary care providers (PCP) are aware of the mental health services we can conduct via telehealth during the COVID-19 public health emergency (PHE). But some of us worry that, between our lack of psychiatric credentials and the added difficulty of delivering these services via video or phone, we may be short-changing our patients. Should we be referring these patients to dedicated mental health providers instead?

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