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Hone in on CPT coding for subsequent hospital care and discharge services

03/14/2022

by: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC

Selecting the appropriate subsequent care code can be daunting as CPT codes 99231-99233 are similar and coding is based, unlike office visits, on the documentation of two of three key components. Sharpen your coding prowess by navigating the differences between the coding and documentation requirements.

Aetna closes the door on office consults

03/14/2022

by: Julia Kyles, CPC

On March 1, Aetna joined the long list of private payers that have cut coverage of office consults (99241-99245).

Transitional care management hit a COVID wall, but denials dropped too

03/14/2022

by: Roy Edroso

While many phone and online services jumped in 2020, transitional care management (TCM) hit a huge snag in utilization. However, despite the lower number of claims, providers had less trouble than ever getting their claims accepted.

Direct primary care, excising the middlemen, paves a novel way

03/07/2022

by: Roy Edroso

Primary care providers and group practices tired of the insurance bureaucracy can consider a shift into direct primary care (DPC), but they should know that the freedom from health plan pressure comes with extra responsibilities.

Complexity of problems addressed: Communicate to clear confusion in MDM table

03/07/2022

by: Julia Kyles, CPC

Add an emerging body of official guidance about the “number and complexity of problems addressed” element of medical decision-making (MDM) to your next training session on E/M office visits (99202-99215). It will bolster your coding and billing efforts.

Court blocks baseline fee determination in No Surprises regs

03/07/2022

by: Roy Edroso

A Texas court vacated one feature of the independent dispute resolution (IDR) process outlined in the federal government’s No Surprise Act regulations, a decision that may result in more providers challenging prices named by the government — and cause them to go up.

Noridian allows multiple same-day E/M visits for multispecialty NPPs

03/07/2022

by: Julia Kyles

Noridian has created a way to recognize — and reimburse — nurse practitioners (NP) and physician associates (PA) who provide specialty care for a multispecialty group.

Direct Contracting model, now ACO REACH, gets caps, governance tweaked

03/07/2022

by: Roy Edroso

After facing bouts of scrutiny, the CMS Global and Professional Direct Contracting (GPDC) Model has a new name, as well as several adjustments to risk calculations, payments and other administrative details (PBN 2/28/22).

All over the map: PA staffing clusters, pay fluctuate by region

03/07/2022

by: Richard Scott

The rapid rise of physician associates (PA) has the profession poised to play an increasingly vital role in health care delivery in the coming years, and billing rules are freeing up opportunities like direct pay (PBN 2/28/22). A look at employment data shows that some states are ahead of the curve in hiring trends.

Direct pay rule creates opportunity for PAs, but states must act

02/28/2022

by: Julia Kyles, CPC

The final 2022 Medicare physician fee schedule includes a section that authorizes direct payments to physician assistants (PA), but practices don’t have to update the enrollment of PAs on staff. In addition, the rule needs to be backed by changes at the state level to make a difference to practices, alter current roles and ameliorate the continued shortage of primary care providers.

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