Part B News | Part B News

OK to promote your practice to outside patients, but watch poaching concerns

05/12/2025

The recent closure of a major practice in Rhode Island, and the efforts of a separate practice to pick up their patients, raises the question: Is it out of line to actively solicit another provider’s patients?

CMS says physician-owned hospital can move location, and add ER

05/12/2025

by: Roy Edroso

Physician-owned hospitals must conform to strict rules under Medicare, but a recent advisory opinion (AO) from CMS suggests a way they can expand their offerings without losing their status.

Keep tabs on OIG’s Work Plan: A road map for compliance

05/12/2025

by: HCPro staff

Since 1976, the Office of Inspector General (OIG) has served as a compliance watchdog, overlooking all HHS programs and monitoring for instances of fraud, waste and abuse. While health care organizations can wait to investigate potential compliance issues until they receive an audit request or gain access to audit findings, you’re better off taking a proactive approach. One important step is monitoring for additions to the OIG Work Plan.

Critical care codes fall hard from COVID boom, resetting trend curve

05/12/2025

by: Roy Edroso

Medicare utilization of many CPT codes, such as outpatient E/M codes, took a beating in the pandemic years. But use of the critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and add-on code 99292 ( … ; each additional 30 minutes) jumped higher during that period.

Solidify your substitute physician billing before you take a leave

05/05/2025

by: Julia Kyles, CPC

Vacation season is about to begin. As more physicians head off for a summer break, practices increasingly will report the services of a substitute provider. But whether a physician will be out of the office for vacation, sick leave, maternity leave, paternity leave or any other reason, your practice needs to review the key points for reporting a substitute physician’s — or some physical therapists’ — services.

Patients worried about autism ‘registry’? Encourage them to ‘be heard.’

05/05/2025

by: Roy Edroso

The recent HHS announcement of an autism “registry” caused an outcry and a pullback. It also raised the question: How safe is your vulnerable patients’ data when the government demands it, and what can your patients do, and what should they know, if they have concerns?

Sharpen reporting, documentation strategies for modifier 25

05/05/2025

by: HCPro staff

You can turn to modifier 25 to help secure complete reimbursement for E/M services, but only when reported appropriately.

Open payments ‘review and dispute’ deadline May 15

05/05/2025

by: Roy Edroso

Your final opportunity to respond to the Open Payments data reported against your providers is Thursday, May 15.

Practices rely on locum tenens when physicians take time off

05/05/2025

by: Julia Kyles, CPC

When it is time for physicians to take a break, they are significantly more likely to bring in a fee-for-time provider, formerly known as a locum tenens, than to rely on a reciprocal billing arrangement, according to a review of Medicare Part B claims data from 2013 to 2023.

Watch locum tenens contract terms to guard against rogue providers

04/28/2025

by: Roy Edroso

A traveling nurse convicted of tampering with morphine raises the question: How responsible is your practice for outside clinical providers hired on a freelance basis?

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