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Booming interest in behavioral health integration signals a new opportunity for practices

11/02/2020

A new multi-organizational collaborative is proving further evidence of the growing interest in behavioral health integration (BHI) with primary care. While reimbursement for integration is unsteady at present, signs suggest this will become a larger and better compensated part of your practice in the years to come — if you’re prepared to implement it.

Tackle CPT coding challenges and ICD-10-CM updates for behavioral health

11/02/2020

by: Sarah Gould

Get a crash course on coding for behavioral health services, which can be tricky given number of conditions that influence mental well-being. Providers must tailor evaluations and interventions to individual needs and adhere to medical necessity standards when billing for services under Medicare.

Narrow your focus: Even if you meet the NCD, missing LCD could cost you

11/02/2020

by: Roy Edroso

A recent OIG investigation, and over $300,000 in potential paybacks, serves as a reminder to check your local as well as your national coverage determination (NCD) before performing and billing Medicare for bariatric weight-loss surgery — or anything else.

4 key questions to prepare for the changing rules of prolonged services

11/02/2020

by: Julia Kyles, CPC

When you train staff on the new rules for prolonged service codes, it’s imperative to know how to accurately capture time spent on an encounter and how to prepare for new guidance in 2021.

Payments, claims flow forth for lucrative psychiatric diagnostic codes

11/02/2020

by: Richard Scott

Provider payments for two psychiatric diagnostic evaluation codes (90791, 90792) maintained steady growth in recent years, returning more than $140 million in fees in 2018, the latest year of available Medicare claims data.

If SCOTUS kills ACA, prepare for uninsured patients till states, Congress act

10/26/2020

by: Roy Edroso

The Supreme Court is again weighing the fate of the Affordable Care Act (ACA) in California v. Texas, and the odds on its repeal seem higher than ever. Some experts think the ACA still has a good chance of surviving. But if all or part of it falls, even many of your non-exchange patients will have to rely on lawmakers to pick up the slack.

Audio-only services, E/M documentation updates major focus of PFS comments

10/26/2020

by: Richard Scott

Various stakeholders are calling on CMS to maintain the current payment rates for audio-only E/M services after the COVID-19 public health emergency (PHE) ends, and others want to see a permanent removal of telehealth restrictions.

E/M and stress tests: When to report a separately payable service with modifier 25

10/26/2020

by: Sarah Gould

Question: A patient with a history of hypertension and high cholesterol visits a cardiologist for an appointment, complaining of occasional chest discomfort during exercise. After the physician completes an office visit, it is determined that the patient needs a cardiovascular stress test, which is performed that day by the same physician. Would it be appropriate to report an E/M code for the visit with modifier 25 (Significant, separately identifiable E/M)?

Modifier 25 does well with E/M codes — and sometimes others

10/26/2020

by: Roy Edroso

Providers seem to vastly favor using modifier 25 (Significant, separately identifiable E/M service) in mid-level established patient visits over any other. But it gets a workout with other codes as well – some of them inappropriately.

Welcome third round of HHS relief funds, eased lending terms for accelerated payments

10/22/2020

by: Roy Edroso

If you took advantage of CMS’ Accelerated and Advance Payment Program, CMS has good news for your repayment responsibilities. And if you also took advantage of the CARES Act Provider Relief program, HHS has good news there as well.

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