Part B News | Part B News

Birmingham billing company pays more than $150,000 to settle fraud allegations

01/30/2023

Providers are responsible for the claims they submit, but a $153,300 settlement paid by a billing company is a reminder that a practice management company risks disruptive investigations, bad publicity and costly settlements if it is accused of submitting fraudulent claims for a provider.

Lots of losers, though few standouts, in 2023 winners-and-losers code tally

01/30/2023

by: Roy Edroso

The Part B professional fee payment for the delayed creation of an exit site for an embedded catheter (49436) has increased 185.8% in 2023, making it the biggest gainer among the codes covered by the Medicare physician fee schedule that went into effect January 1.

Thwart new ransomware threats, and ‘triple extortion,’ with leveled-up security

01/23/2023

by: Roy Edroso

Ransomware attacks on health care organizations, including physician practices, show no sign of slowing down, and lately they have grown more sophisticated and dangerous. Pay attention to specific warnings from experts in the field.

Changes to ICD-10-CM code set, guidelines cover abuse, neglect, SDOH

01/23/2023

by: DecisionHealth Staff

Come April 1, coders will have additional code options to further capture social determinants of health (SDOH) and abuse and neglect, as CDC released upcoming changes to both the code set and official guidelines on Jan. 9.

Use social determinants of health to reduce burnout, increase patient care

01/23/2023

by: Julia Kyles, CPC

The new batch of diagnosis codes and revised guidelines for social determinants of health (SDOH) that will go into effect April 1 highlight the importance policymakers place on capturing this data. For physicians and qualified health care professionals that are skeptical, let them know that collecting the information can improve patient encounters — and it might not be as much work as they think.

Nurse practitioners reap massive pay gains after E/M fee surge

01/23/2023

by: Richard Scott

Following the pandemic-induced sag in patient encounters in 2020, nurse practitioners nearly returned to pre-COVID levels in 2021 — and with federal dollars buoying E/M services, their payments roared to new heights.

Tap, tap: See better patient results, and provider scores, with SMS outreach

01/16/2023

by: Roy Edroso

A recent study shows automated text messaging to transitional care management (TCM) patients was tied to reduced readmission to the hospital and ED, suggesting that these SMS interventions can go beyond patient-provider convenience and actually improve patient care. They may also boost provider performance ratings — in payer programs and at review websites.

CMS posts new +2.4% conversion factor for 2023 Medicare fees

01/16/2023

by: Richard Scott

On the heels of the omnibus spending bill that President Biden signed into law Dec. 29, CMS has taken up one of its imperatives to scale down the reduction in Medicare payments. The agency posted a revised conversion factor of $33.8872, replacing the $33.0607 amount originally released with the final 2023 Medicare physician fee schedule.

CMS adds 35 codes to the Stark list of designated health services

01/16/2023

by: Julia Kyles, CPC

Remember to add the latest designated health service (DHS) codes to your practice’s compliance plan. For the first time CMS did not release the updated list in the final Medicare physician fee schedule.

Master ICD-10-CM coding for various types of diabetes mellitus

01/16/2023

by: Shelley C. Safian

Diabetes mellitus is an insidious condition, as it invades the body in many different ways. This chronic disease causes elevated levels of glucose in the blood. If left untreated, this systemic condition leads to serious damage to multiple body systems. Ensure you’re capturing your patients’ details correctly to depict accurate coding.

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