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CMS creates 3 new prolonged codes, won’t assign frequency limits

11/14/2022

Practices that report E/M services based on time could have to juggle up to six prolonged service codes in 2023 depending on where providers treat patients and on individual payer policy. CMS finalized three new prolonged service codes that will be reported based on the setting for the primary service — G0316, G0317 and G0318 — and issued additional policies for prolonged service codes.

Prolonged service threshold chart

11/14/2022

by: Julia Kyles, CPC

Share this prolonged service code chart with coders to ensure accurate claims. The first column lists the primary E/M code, followed by the add-on HCPCS code that pairs with the primary code. The threshold column contains the minimum time required to report one unit of the add-on code.

CMS extends its split/shared exception for facility-based visits

11/14/2022

by: Julia Kyles, CPC

Practices have another year to determine whether a physician or qualified health care professional bills a level-based split/shared visits based on performance of a key component of the encounter — history, physical exam or medical decision-making (MDM).

QPP changes arrive, as later reporting, payment hassles loom

11/14/2022

by: Roy Edroso

Take stock of a series of annual updates to the Quality Payment Program (QPP) and Merit-based Incentive Payment System (MIPS) to succeed in 2023, but watch carefully as CMS prepares for a whole new MIPS paradigm and, for alternative payment model (APM) participants, a possible year without bonuses down the road.

Shared Savings offers rewards for ACOs in underserved areas, but others can benefit

11/14/2022

by: Roy Edroso

By finalizing most of its proposed changes to the Medicare Shared Savings Program (MSSP), CMS is giving massive breaks to new and low-revenue accountable care organizations (ACO) that serve underserved communities, as well as enticements for others to stay. The agency evidently wants to bulk up enrollment, and some experts think it’s worth a try.

Fee schedule round-up: More policy updates coming your way

11/14/2022

by: DecisionHealth Staff

Don’t miss out on additional regulatory changes contained in the final 2023 Medicare physician fee schedule, from global period E/M visits to supply cost revisions and more.

Most specialties projected to lose charges in 2023: Fee schedule

11/14/2022

by: Richard Scott

The number of specialties welcoming a boost to their allowed charges in 2023 is far outpaced by those facing projected cuts, according to relative value unit (RVU) revisions announced in the final 2023 Medicare physician fee schedule released Nov. 1.

MACs team up on national urine drug test policy ‘that will shock some people’

11/07/2022

by: Julia Kyles, CPC

If your practice orders or performs urine drug tests (UDT), take note: Your Medicare administrative contractor (MAC) is working on a new policy for these high-utilization services, and it could go into effect in the next few months.

AMA alerts practices to hidden E/M pay cuts by private payers

11/07/2022

by: Julia Kyles, CPC

Watch your payers’ communications and your remittance advice codes for signs of stealth pay cuts and automatic downcoding, the AMA warns in a 15-page guide the association announced in an email Oct. 21.

CDC loosens up on masks; whether you agree or not, set a clear policy

11/07/2022

by: Roy Edroso

Recent CDC guidance suggests some added flexibility in mask use in medical facilities. If the guidance doesn’t track with your own masking policy, make sure your staff and patients are clear as to where you stand.

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