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OIG still watching PODs closely; review the list of suspect arrangements

04/26/2021

Before your doctors start or invest in a physician-owned distributorship (POD), make sure they know the arrangement will increase their compliance risk and be subject to intense scrutiny by investigators.

Sequester cuts delayed (again); MACs will reprocess docked claims

04/26/2021

by: Richard Scott

Providers gained a fresh reprieve from the sequestration payment adjustment that had been on track to dock 2% of Medicare payments starting April 1.

Proposed long-haul COVID ICD-10 code could take effect Oct. 1

04/26/2021

by: Laura Evans CPC

Providers could get a new diagnosis code to report for their post COVID-19 cases when the patient continues to have lingering symptoms after the infection is gone, ICD-10-CM officials announced last month.

Nursing facility payments show strong growth, as NPs boost their claims

04/26/2021

by: Richard Scott

Providers pulled in nearly $1.5 billion in payments for subsequent nursing facility encounters in 2019, continuing a strong rate of growth largely fueled by an uptick in nurse practitioner visits.

Did you get COVID relief funds? Prepare to pay it back, make ‘good faith’ efforts

04/19/2021

by: Roy Edroso

A little over a year into the pandemic, the feds are starting to look at COVID-related loans, grants and other payments, and they’ve started to prosecute businesses they believe have misused them. If you took relief money, make sure you can back up your right to it — and give it back if you can’t.

CMS starts recouping accelerated, advance payments tied to COVID

04/19/2021

by: Roy Edroso

On March 30, CMS started recouping the Accelerated and Advance Payments it gave out during the early days of the pandemic, and the agency will keep it up until it gets all the outstanding dollars.

Early E/M insights, Part II: Solve confusion surrounding MDM rules

04/19/2021

by: Shannon McCall, RHIA, CCS,CCS-P, CPC, CEMC, CRC, CCDS, HCS-D

This is part two of a two-part series on the new 2021 E/M office visit guidelines.

Effective Jan. 1, physicians billing under Medicare can base E/M level selection for outpatient visits on time or complexity of medical decision-making (MDM). When using MDM as the basis for level selection, physicians must consider three elements.

CMS widens telehealth billing window in nursing facility setting

04/19/2021

by: Richard Scott

You can take advantage of greater flexibility when reporting telehealth services to patients in the nursing home setting. CMS will now permit encounters once every 14 days, instead of once per month.

Latest telehealth-approved codes arrive after year of lobbying, education

04/19/2021

by: Julia Kyles, CPC

Medical practices gained an additional 24 codes that they can report via telehealth during the COVID-19 public health emergency (PHE) after CMS approved a slate of codes tied to hearing, speech and cognitive therapy.

Can your MA handle the TCM initial patient contact? Yes — until the patient responds

04/19/2021

by: Roy Edroso

Question: We often do the initial patient contact for transitional care management (99495, 99496) that has to occur within two days of discharge by email or text. Do we need the M.D., or even a nurse practitioner or physician assistant, to do this? Can’t my medical assistant do the outreach?

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