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CMS issues two comment requests on ABNs, self-referrals

09/19/2022

On September 7, CMS published two comment requests in the Federal Register. The first request pertains to the Advance Beneficiary Notice of Noncoverage (ABN).

Providers amped up 60-minute psychotherapy service in 2020

09/19/2022

by: Richard Scott

Many psychotherapy services dipped in 2020; however, the 60-minute therapy service code gained claims while Part B payments grew by $28 million. And aside from psychiatric specialists, nurse practitioners were most likely to report a psychiatric diagnostic evaluation when also performing a separate E/M service.

Is the PHE ending? As CMS signals yes, prepare for policy, compliance changes

09/12/2022

by: Roy Edroso

A provocative post from CMS reminds us that the COVID public health emergency (PHE), in place since Jan. 31, 2020, won’t last forever. It appears the agency is preparing for the end, and so should your practice.

E/M sections of proposed fee schedule spark demand for unified policies

09/12/2022

by: Julia Kyles, CPC

CMS is receiving pushback on its plan to create three new prolonged services codes that would take effect Jan. 1. A review of comments submitted for the proposed 2023 Medicare physician fee schedule shows that health care stakeholders, ranging from specialty societies to individual coding consultants, have urged CMS to abandon its plan.

Closeout, part II: Clear legal, financial hurdles when closing a practice

09/12/2022

by: Roy Edroso

Beyond the previously-covered handling of patient records after a practice shutters, owners or partners will have to deal with parties affected by their closing — payers, patients, creditors, the medical board and others. It’s not as simple as turning out the lights and locking up; you must prepare to accommodate the needs of all the parties involved.

Individuals, group performers saw largest quality-score losses in 2020

09/12/2022

by: Julia Kyles, CPC

Individual clinicians and practices continued to take part in the Quality Payment Program (QPP) during the first year of the COVID-19 pandemic. However, there were shifts in how many participants met or exceeded performance thresholds in 2020 compared to 2019, according to a CMS fact sheet.

Inflation Reduction Act caps insulin costs, grants CMS drug negotiating power

08/29/2022

by: Roy Edroso

Many of the health care changes in the Inflation Reduction Act, signed into law by President Biden on Aug. 16, will be rolled out over time, but the effect of the insulin cost ceiling and other aspects of the law are likely to have a more immediate impact on your patients.

Focus on practitioner preference, end users when you update E/M templates

08/29/2022

by: Julia Kyles, CPC

Make sure treating practitioners and coding staff work together when the practice revises its electronic health record (EHR) templates ahead of the next round of E/M changes (PBN 7/11/22). The second E/M update will move the remaining level-based codes to the office/other outpatient model and gives your practice the opportunity to rethink and improve its templates.

For patients with challenges, hearing aid rule gives providers OTC options

08/29/2022

by: Roy Edroso

The final rule on over-the-counter hearing aids from HHS and the Food and Drug Administration (FDA) clears a new category of sub-prescriptive hearing devices that may offer your patients a welcome alternative.

Don’t let OIG fraud alert disrupt your practice’s telehealth program

08/29/2022

by: Julia Kyles, CPC

The latest special fraud alert warned treating practitioners about telemedicine companies that recruit providers in order defraud Medicare and other programs (PBN 8/15/22). However, the alert should not discourage you from using the COVID-19 public health emergency (PHE) waivers to provide telehealth services to your patients.

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