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Prolonged service utilization showed major ups, downs over 3-year period

02/21/2022

The use of prolonged services had their ups and downs in recent years, showing sharp swings between 2018 and 2020, and the COVID-19 crisis did not appear to have a negative impact on all codes.

Check your numbers as Provider Relief Fund spigot keeps running

02/14/2022

by: Roy Edroso

The fourth phase of the Provider Relief Fund (PRF), originally planned to end in December, is still delivering payments to health care providers. The ongoing disbursement serves as a reminder to report your previous PRF payments and, if you want the feds to recalculate your most recent payment, make sure it’s worth an audit risk.

Urine drug testing settlements signal suspicious coding, documentation patterns

02/14/2022

by: Julia Kyles, CPC

State and federal prosecutors continue to extract sizable settlements from practices that allegedly submitted fraudulent claims for one type of service — urine drug tests (UDT).

Can I shift unvaccinated patients to telehealth? Experts say there’s a case

02/14/2022

by: Roy Edroso

Question: I read about a rheumatologist in Santa Fe restricting her patients who chose not to vaccinate against COVID-19 to telehealth because she considered their presence in the practice dangerous to her immunocompromised patients. Does this raise patient abandonment issues?

Limit psychological testing to approved providers

02/14/2022

by: Sarah Gould

Question: Which providers can perform and bill for psychological testing services described by CPT codes 96136-96139?

OIG audit targets excessive billing for genetic testing

02/14/2022

by: Sarah Gould

Between 2016 and 2019, Medicare payments to laboratories for genetic tests quadrupled from $351 million to $1.41 billion. This sharp increase in spending on genetic testing is likely linked to excessive and fraudulent billing, according to a recent Office of Inspector General (OIG) report.

Negative results: Urine drug test denials hold bad news for family practices

02/14/2022

by: Julia Kyles, CPC

CMS made its last major update to urine drug testing (UDT) codes in 2017, when it deleted three HCPCS codes for presumptive drug tests (G0477-G0479) and adopted three new CPT codes (80305-80307) that picked up the outgoing G codes’ descriptors.

CMS’ vaccine rules lay out staff deadlines, how to handle hold-outs

02/07/2022

by: Roy Edroso

Heed fresh guidance that CMS issued on its vaccine mandate, which the Supreme Court cleared in January. The new regulations clarify the rules for facilities and the providers, including those primarily toiling in practices, who work at them.

Discover 3 benefits in new critical care rules; provider training is a must

02/07/2022

by: Julia Kyles, CPC

The new split/shared option for critical care services is a major change to Medicare’s policy (PBN 11/15/21). But the ability to combine physician and non-physician practitioner (NPP) work is just one of the high-impact changes — with the potential to confer benefits on your practice — covered in CMS 100-04, Change Request 11181, which the agency published Jan. 14.

Take care when you share clinical notes with patients, implement 5 tips

02/07/2022

by: Marla Durben Hirsch

Under recent rule changes, your practice’s physicians, qualified health care professionals and clinical staff should be prepared to share clinical notes with patients. The interoperability rule banning information blocking that took effect in 2021 may mean that more patients will be asking for their electronic health information (EHI).

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