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Stick to current POS guidelines for post-PHE telehealth visits

04/10/2023

Question: Our practice will continue to perform telehealth office visits (99202-99215) under the waiver extension. Which place of service (POS) should we use for Medicare patients after the COVID-19 public health emergency (PHE) ends?

Retirement crunch: Docs cite burnout, cash; administrators don’t see it

04/10/2023

by: Richard Scott

Amid reports of a potential retirement crisis among medical groups, administrators are underestimating the reason that many physicians are heading for the exits. Physicians indicate that burnout and financial concerns are two of the leading reasons to hang it up, yet few administrators see it that way.

April 1, 2023 ICD-10-CM code file

04/04/2023

by: Julia Kyles, CPC

Bring your staff up to date on the ICD-10-CM code changes that went into effect April 1.

At end of PHE, patients will hunt for tests, incur costs; prepare now

04/03/2023

by: Roy Edroso

Facts on the ground are changing in real time, but some trends clearly show what you can expect after the end of the COVID public health emergency (PHE): a return to pre-COVID standards in many legal and regulatory areas, while patients who no longer have free COVID-related services will likely seek them from physician practices.

3 NPP policies created during the PHE won’t change after May 11

04/03/2023

by: Julia Kyles, CPC

Medicare expanded the services non-physician practitioners (NPP) can perform during the COVID-19 public health emergency (PHE). A recent CMS change request serves as a reminder that some of the flexibilities are now permanent, even after the PHE ends May 11, 2023.

MedPAC recommends inflation-adjusted physician payment, add-on fees

04/03/2023

by: Roy Edroso

The latest MedPAC report to Congress, released March 15, includes a proposal to boost physicians' 2024 Medicare payments based on the Medicare Economic Index (MEI). This has intrigued industry groups, although they aren’t satisfied with the numbers. The Medicare watchdog also suggests standing bonuses for some care delivered to poorer patients and reiterates its concerns about Medicare Advantage.

Refresh the basics of anti-kickback statute compliance

04/03/2023

by: DecisionHealth Staff

Certain aspects of the anti-kickback statute (AKS) and the Stark law were subject to COVID-19 public health emergency (PHE) waivers. These flexibilities are set to expire with the end of the PHE on May 11. After that date, organizations must comply with these laws as they did prior to the issuing of the PHE waivers in March 2020.

Denials quadrupled after hospital outpatient prior-auth policy took hold

04/03/2023

by: Julia Kyles, CPC

Denials spiked for a variety of services performed in the hospital outpatient setting even as utilization tumbled, and a Medicare prior authorization policy may be one reason behind the change.

New math for prolonged hospital visits could equal revenue surge for practices

03/27/2023

by: Julia Kyles, CPC

Check your practice’s highest-level inpatient and observation E/M visit claims (99223, 99233 and 99236). Medicare’s revised threshold times for add-on code G0316 (Prolonged inpatient or observation services by physician or other QHP) may have opened the door to more revenue for hospital visits that are coded based on time.

Time change: Revised prolonged service threshold chart

03/27/2023

by: Julia Kyles, CPC

Use this updated threshold chart for prolonged E/M services associated with same-day, face-to-face visits performed by physicians and qualified health care professionals (QHP). Medicare has revised the threshold times for prolonged service code G0316, effective Jan. 1.

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