Part B News | Part B News

First inflation-rebate drug prices hit April 1 in rollout of CMS drug policy

03/27/2023

CMS has rolled out its first wave of Part B and Part D drug policy innovations, and medical groups and some patients and providers will feel some effects — specifically lower co-insurance for Medicare beneficiaries on 27 drugs, effective April 1 — pretty quickly. Others will take time to kick in.

No Surprises IDR freeze ends; new guidance may (or may not) sway litigants

03/27/2023

by: Roy Edroso

A month after a second court loss on its No Surprises Act (NSA) independent dispute resolution (IDR) process that led to a temporary freeze, HHS has restarted the IDRs and issued new guidance — though there’s no guarantee the litigants who beat them will be satisfied.

Pick up the tab: Review proposed changes to the ICD-10-CM tabular section

03/27/2023

by: Julia Kyles, CPC

Review proposed changes to ICD-10-CM tabular section that are slated to go into effect Oct. 1 while you wait for the proposed changes to the code set that Medicare will release in the FY2024 hospital inpatient prospective payment system (IPPS) proposed rule.

Ensure compliance with added, deleted digestive system codes

03/27/2023

by: Savannah Schmidt

Have your coding and procedure updates for the digestive system go down easy by understanding the nuances of the changes within the 2023 CPT code set. You’ll find more than a dozen deleted codes and new codes to replace them, as well as fresh code-bundling guidance.

Some drugs with co-insurance cuts have low usage, high denials

03/27/2023

by: Roy Edroso

The lowered co-insurance rates on some average sales price (ASP) drugs in the 2nd quarter of 2023 is good news for some Part B drug users. But these modest cuts still represent only a small percentage of Medicare’s enormous drug tab.

Even patients get the blues: 4 ways to counter patient burnout

03/20/2023

by: Roy Edroso

A recent report on “patient burnout” is a reminder that doctors aren’t the only ones who get discouraged by the health care system, and that you can find ways to make the patient’s experience with your practice a happier one.

Telehealth after May 11 is possible, but keep track of the waivers’ expiration dates

03/20/2023

by: Julia Kyles, CPC

Check the expiration date for each COVID-19 waiver you use to provide telehealth as your practice prepares for the end of the COVID-19 public health emergency (PHE).

Medicare trims 15 minutes from prolonged hospital visit times

03/20/2023

by: Julia Kyles, CPC

Your providers will find it easier to hit the required time for a prolonged inpatient or observation visit thanks to a correction to the final 2023 Medicare physician fee schedule. The update, announced today, cuts 15 minutes from the threshold times for G0316 (Prolonged inpatient or observation services by physician or other QHP).

Tough Medicare Advantage risk adjustment, audits coming; pay impact seen

03/20/2023

by: Roy Edroso

Proposed adjustments to the codes used to risk-adjust Medicare Advantage rates have stirred discontent among physician groups as well as insurers, suggesting that these groups expect lower reimbursement as a result.

When will it end? Track PHE waiver expiration, watch for updates

03/20/2023

by: Julia Kyles, CPC

The COVID-19 public health emergency (PHE) will end May 11 and with it more than a dozen waivers that were created during the emergency will disappear. However, the end of the PHE will not spell the end of every waiver.

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