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Per-patient E/M payments fluctuate by state; use them for audits

08/30/2021

Use Medicare’s average per-patient payment for all E/M visits in your state as the starting point for your internal review of E/M claims to see how your payments compare to those of your peers in the same area.

Get granular: New ICD-10-CM guidelines place an emphasis on specificity

08/23/2021

by: Julia Kyles, CPC

Alert your clinical and coding team to the dozens of ICD-10-CM guideline updates that will go into effect Oct. 1. Changes that will impact coding are scattered through the guidelines and range from a new call for specificity to revised instructions for coding social determinants of health (SDOH).

Providers voice concern over HIPAA Privacy Rule proposals

08/23/2021

by: Dom Nicastro

HHS published public comments on its notice of proposed rulemaking on modifications (NPRM) to the HIPAA Privacy Rule on June 24, and some providers are wary of the shortened window they would have to release patients’ protected health information (PHI).

CMS will pay for booster COVID shots for the immunocompromised

08/23/2021

by: Richard Scott

On Aug. 12, the Food and Drug Administration (FDA) revised the emergency use authorizations (EUA) for the Pfizer and Moderna COVID-19 vaccines, approving booster shots for immunocompromised individuals, and CMS later announced it would cover the extra shots.

ESRD code tops list of fee winners; cardio codes lose big

08/23/2021

by: Richard Scott

You can expect big pay gains for chronic care management (CCM) codes in 2022, but that’s not the only service in line for a reimbursement surge. By strict dollar gains, the biggest winner for services in the non-facility setting is monthly end-stage renal disease service code 90954, with fees up $206 year to year.

New CMS opinion hints that buying ‘subsidiary’ practices OK under Stark exception

08/16/2021

by: Roy Edroso

A recent advisory opinion (AO) from CMS explicitly answers a question about whether acquiring subsidiary practices is acceptable under the Stark Law, and some experts suggest it will encourage more practices to do so. That may further fire up an already hot practice acquisition market.

Add-on smartly: Tackle CPT coding for E/M visits with psychiatric care

08/16/2021

by: Shelley C. Safian

Accurately reporting CPT codes for psychiatric care services can be challenging, especially when these services are provided in conjunction with a primary E/M service.

Cloned notes can lead to legal trouble – run audits, ‘use cases’ to minimize risk

08/16/2021

by: Roy Edroso

Question: We know that if we’re not careful our cloned notes can lead to inappropriate data in an encounter record, which in turn can lead to denials and takebacks. But can you be prosecuted for fraud because of cloned notes?

Don’t chain social determinants of health for MDM risk to ICD-10-CM codes

08/16/2021

by: Julia Kyles, CPC

Question: We are considering the following policy for E/M visits: Coders can’t select moderate risk because a social determinant of health (SDOH) affected the diagnosis or treatment, unless the note supports an SDOH diagnosis code from the Z55-Z65 range (Persons with potential health hazards related to socioeconomic and psychosocial circumstances). That way we can make sure the risk level is supported by the note.

Avoid routinely waiving patient copays; follow these tips instead

08/16/2021

by: Laura Evans, CPC

Question: The doctor asks to not charge a patient for any of their visits. The patient has Medicare. Is it legal to bill Medicare and write off the patient’s portion or to write off the entire charge and not bill Medicare at all?\

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