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Early E/M insights, Part I: Review guidance for reporting time-based encounters

04/12/2021

The most impactful overhaul to the E/M coding and documentation guidelines in 25 years went live Jan. 1. The updated guidelines eliminate medical history and physical examination as required elements for reporting E/M codes 99202-99215. E/M coding for outpatient visits is now based on documentation of medical decision-making (MDM) or time spent on the encounter.

Warning: Marketing, practice support from manufacturers can raise fraud risk

04/12/2021

by: Marla Durben Hirsch

Review any form of help you receive from corporations, such as pharmaceutical companies and medical device manufacturers. While physicians know to say no to all expenses-paid vacations from manufacturers, accepting less obvious forms of remuneration could also violate the anti-kickback statute.

Take 4 steps before you accept advertising, practice support

04/12/2021

by: Marla Durben Hirsch

Free help with marketing or practice assistance from a medical manufacturer can put you on the wrong side of the anti-kickback statute.

Medicare adds 24 services to telehealth eligibility list during PHE

04/12/2021

by: Julia Kyles, CPC

Practitioners who perform hearing, speech and cognitive therapy now have more services they can provide via telehealth during the COVID-19 public health emergency (PHE).

CMS pauses claim payments until Congress passes sequester fix

04/12/2021

by: Kevin Duffy

CMS is holding payments for claims submitted on or after April 1 in anticipation of legislation that will extend the suspension of a 2% cut to all Medicare payments, according to a special edition of MLN Connects.

Interprofessional consults slow to lift, but fees can pad your revenue

04/12/2021

by: Richard Scott

Medical practices showed a tepid response to the launch of a series of interprofessional consultations in 2019, the first year that CMS approved the codes for reimbursement.

Becerra confirmed; experts see strong ACA defense, partner for providers

04/05/2021

by: Roy Edroso

He’s been a health system trust-buster and a Medicare for All advocate, but in his new role as HHS Secretary you can expect Xavier Becerra to be more of a team player than a firebrand. However, in areas where his instincts and President Joe Biden’s intersect, such as the expansion of Obamacare, you may see a faster-than-normal rate of progress under his leadership.

Medically unlikely edit update caps prolonged office visits at 4 units

04/05/2021

by: Julia Kyles, CPC

You’ll have to go through the cycle of file, denial and appeal if you report more than 60 minutes of prolonged services with office E/M visits 99205 or 99215 when the visit is coded based on time.

10 elements of the mandatory HIPAA security risk analysis

04/05/2021

by: Marla Durben Hirsch

Conducting a security risk analysis to comply with HIPAA’s security rule has become even more paramount now that the HHS Office for Civil Rights (OCR) has released its new audit report.

When figuring out modifier 52 vs. 53, think: What’s the effect on the patient?

04/05/2021

by: Roy Edroso

Question: What’s the difference between modifiers 52 (Reduced services) and 53 (Discontinued procedure)? They seem pretty similar, because in both cases you stop part-way through.

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