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Meet 4 challenges that linger in your E/M office visit services

12/09/2024

The major revisions to the coding guidelines for office/other outpatient E/M visits (99202-99215) are almost four years old. While the update streamlined the process of coding, practices continue to face challenges when they document and report these services. That confusion can create pain in the pocketbook when it results in improper coding.

Proposed CMS director big on youth outreach, Medicare Advantage

12/09/2024

by: Roy Edroso

The man that incoming president Donald Trump wants as his CMS administrator, cardiothoracic surgeon Mehmet Cengiz Oz, M.D., known primarily as the television entertainer “Dr. Oz,” has no government administrative experience. But he has been involved in health outreach initiatives and has expressed views on public health, some of which are relevant to his proposed role.

Put nurse practitioners in charge of chronic pain care management

12/09/2024

by: Julia Kyles, CPC

CMS introduced a new care management code set (G3002-G3003) for chronic pain management in 2023. Based on a review of the latest Medicare Part B claims data, nurse practitioners reported the majority of claims.

HIPAA Q&A: Take an inside tour of the HHS Cybersecurity Performance Goals

12/09/2024

by: Julia Huddleston

Part B News welcomes Julia Huddleston, CIPP/US, CIPM, CCSFP, principal with Apgar and Associates, to shed light on HHS’ recent cybersecurity performance efforts and how medical groups can follow the agency’s goals to bolster their security.

Nary a fee increase among high-volume selected procedures

12/09/2024

by: Richard Scott

The conversion factor shave of -2.8% will have a fee-slashing effect on many services in 2025. Due to relative value unit (RVU) adjustments, some codes will net a fee increase next year. But all of the high-volume codes, as labeled by CMS and shown in the chart below, are on pace for reductions in both non-facility and facility settings.

CMS tweaks telehealth rules ahead of waiver expiration date

11/25/2024

by: Julia Kyles, CPC

Practices that treat patients who were eligible for telehealth services before the COVID-19 public health emergency (PHE) take note: Even though the original telehealth rules and requirements will be restored on Jan. 1, 2025, CMS will hang on to a few waivers, including a permanent change for audio-only services.

For hospital visits, CMS clarifies infectious disease add-on code

11/25/2024

by: Julia Kyles, CPC

Infectious disease specialists should take note of the user-friendly adjustments and clarifications that CMS made to the final version of the new infectious disease consultant add-on code that will go into effect Jan. 1, 2025. For example, CMS clarified that eligible qualified health care professionals (QHP) can report the service.

Third-party biller fraud may hook your practice, unless you protect yourself

11/25/2024

by: Roy Edroso

Question: I recently read about a third-party biller who was charged with health care fraud and eventually entered a plea agreement — but the practice he worked for was not charged. I thought fraudulent medical billings were always the responsibility of the provider whose services were billed. Is it possible for a biller to be guilty but not the provider?

Stay up to date with NCCI edits: Mind modifiers, override edits

11/25/2024

by: HCPro staff

At its core, the National Correct Coding Initiative (NCCI) is designed to reduce improper coding and billing practices across CMS programs. Keep up to date with policy manual changes and the latest modifier guidance to keep your claims accurately processed.

Final Medicare fees mostly losers, with CMS tracking to save 4.4%

11/25/2024

by: Roy Edroso

In the rates for Medicare-payable services codified in the physician fee schedule final rule, losers outpace winners — and the winners aren’t doing so well, either.

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