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Navigate modifier reporting for COVID-19 visits to ensure your claims get paid

07/27/2020

In response to the novel coronavirus (COVID-19) public health emergency (PHE), CMS has expanded patient access to telehealth services, allowing beneficiaries to receive a wide range of services without having to visit a health care facility.

Can you amend time on encounter notes? Yes — but don’t make a habit of it.

07/27/2020

by: Roy Edroso

Question: I have a doctor who’s billing critical care codes without putting the relevant times in his notes. We send these back to him and he amends them properly. Could this still be trouble for us down the road?

Robust TCM payment growth slows but still sees double-digit results

07/27/2020

by: Richard Scott

The ascendance of transitional care management (TCM) payments and claims may be slowing, but the codes (99495-99496) continue to maintain strong year-to-year growth, most recently reaping more than $186 million in Part B payments.

If your provider gets COVID: A 5-step plan to ease patients’ minds, adhere to privacy rules

07/20/2020

by: Roy Edroso

With COVID-19 a focus of so much patient concern, you should take special care to reassure them when one of your providers comes down with it.

New ICD-10-CM guidelines revise COVID-19 instructions, advise on social factors

07/20/2020

by: Julia Kyles, CPC, and Laura Evans, CPC

Coders and medical practice staff can get a head start on a series of updated rules for diagnosis coding — the 2021 version of the ICD-10-CM Official Guidelines on Coding and Reporting was issued on July 8, weeks ahead of the typical early August release date.

Think ahead for Physician Compare review: It can’t help 2018 scores but may help future ones

07/20/2020

by: Roy Edroso

Is it worth going in and looking at the expanded performance review data CMS has for your Physician Compare page? While only some providers can actually change or suppress their scores, you can use the opportunity to get your providers serious about making a better showing next time, when their score may count for a great deal more.

Generous MUEs for office visits haven’t changed the rules for same-day visits

07/20/2020

by: Julia Kyles, CPC

Question: I’m trying to figure out the impact of the new medically unlikely edits (MUE) for E/M codes 99201-99215. All codes have an MUE of 24. Does that mean a patient can see multiple physicians of the same specialty who bill under one tax ID on the same date of service? For example, could I bill two E/M visits if a patient saw Dr. Smith for shoulder pain and then saw Dr. Jones for knee pain?

APMs, QPs and groups gain, virtual groups vanish in Quality Payment Program Report

07/20/2020

by: Roy Edroso

CMS’ 2018 Quality Payment Program (QPP) Experience Report that came out on July 7 suggests that Alternative Payment Models (APMs) are slowly gaining on traditional individual and group reporters — and virtual groups are washing out.

Final 2021 ICD-10-CM update confirms hundreds of codes, including fractures, CKD and COVID-19

07/13/2020

by: DecisionHealth staff

You can plan to see nearly 500 codes — including the two new U codes for COVID-19 and vaping-related disorders — added to the ICD-10 code set this year.

Latest Section 1557 rule rescinds trans patients’ rights, but SCOTUS has other ideas

07/13/2020

by: Roy Edroso

HHS finalized the Section 1557 final rule last month, which would seem to remove civil rights protections for trans or non-binary patients seeking federal payer coverage for treatment. But other events, including a recent Supreme Court decision, suggest that little has changed for providers as far as discrimination against such patients is concerned, and you should proceed as if it has not.

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