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First in series of surprise billing rules promises big payment, patient info changes soon

07/12/2021

The first of an anticipated series of rules related to surprise billing is out, and suggests that the government will enforce a low ceiling for out-of-network charges — and require practice physicians to explain to an unprecedented degree what payment options the patient has.

New HITECH amendment rewards good cybersecurity hygiene

07/12/2021

by: Marla Durben Hirsch

Now’s a great time to shore up your cybersecurity practices. A new amendment to the Health Information Technology for Economic and Clinical Health (HITECH) Act requires the HHS Office for Civil Rights (OCR) to take into account whether your practice adopted “certain recognized security practices” if it investigates your practice for HIPAA compliance. The amendment applies to business associates, too.

More than 8 million patients affected by HIPAA breaches this year

07/12/2021

by: Julia Kyles, CPC

Check on your practice’s network and email security protocols. A look at breaches reported by health care providers shows that hacking and IT incidents were associated with the largest breaches in the first six months of the year.

Go to the source when you count review of external notes

07/12/2021

by: Julia Kyles, CPC

Question: I understand how to count tests that are ordered or reviewed for office visits. But I’m not sure how to count “the prior review of external note(s) from each unique source.” Does the review of one note from one physician or qualified health care professional (QHP) from a different group or specialty count as one source?

Medicare Advantage takes another bite out of traditional FFS enrollment

07/12/2021

by: Richard Scott

Medicare Advantage enrollment galloped forward at a 10% rate between 2020 and 2021, as the private plan alternative to original Medicare now has lassoed more than four in 10 (42%) beneficiaries.

Practices’ claim on top doc prospects getting weaker; recruit for staying power

07/05/2021

by: Roy Edroso

As fewer physicians enter the market from medical schools and practices cease to be the first choice of those who do, experts suggest you be mindful of the new doctors’ needs — but also recruit with an eye toward potential partners who will grow with you and vice versa.

Proposed uniform policy would reshape epidurals for chronic pain

07/05/2021

by: Julia Kyles, CPC

Review the proposed uniform policy for cervical/thoracic and lumbar/sacral epidural injections and use the open comment period to help shape the final policy.

Medical necessity for epidurals – proposed uniform policy

07/05/2021

by: Julia Kyles, CPC

Take note of the proposed medical necessity requirements for epidurals to treat chronic pain. Each service must meet all three of the following elements.

Part II: Plan ahead for a quicker records request mandate in the Privacy Rule

07/05/2021

by: Dom Nicastro

As HHS mulls significant changes to the HIPAA Privacy Rule, it’s likely that the 15-day requirement to share patients’ medical records could easily stick.

Using preventive prolonged service codes? Log at least 16 minutes over

07/05/2021

by: Roy Edroso

Question: Our provider did a depression screening billable with G0444 (Depression screening, 15 minutes) and went a little over the 15 minutes required. The provider thinks we should add the prolonged preventive service code G0513 (Prolonged preventive service[s] [beyond the typical service time of the primary procedure], in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes [list separately in addition to code for preventive service]). Our provider didn’t add anywhere near 30 minutes to the session, however. Can we still claim it?

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