Part B News | Part B News

Directory glitch caused patient overcharge? Under NSA, you pay, not the plan

08/08/2022

Question: I know the No Surprises Act (NSA) and the CMS rules that put it in practice require that provider directories be kept up to date. But I thought that was all the insurers’ responsibility. The other day I was looking at guidance from a CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) that says, among other things, “Under the No Surprises Act, providers and health care facilities must generally ... refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information.” Why is this the providers’ responsibility?

At top and bottom of 2023 fee changes, some big hits, soft landings

08/08/2022

by: Roy Edroso with additional reporting by Laura Evans

The almost 4% proposed cut to the 2023 conversion factor would, if finalized, have a powerful negative effect on many of the most-used Part B procedure and E/M codes. Factoring in changing relative value units (RVU) reveals some big winners and losers on a per-service basis.

Great unmasking? Some practices ease on masks, but experts urge caution

08/01/2022

by: Roy Edroso

After two-plus years of COVID, mask compliance appears to be weakening, even in medical practices. Experts suggest you keep an eye on regulations and weigh the specifics of your setting and patient preferences to determine your best options.

Use the preview of new and revised CPT codes to prepare for 2023

08/01/2022

by: Julia Kyles, CPC

Get an early start on 2023 with a look at the CPT codes that will be added, revised and deleted next year. Analysis of the proposed 2023 Medicare physician fee schedule reveals changes to 10 chapters in the CPT manual, in addition to the revisions to the E/M chapter.

Medicare’s proposed plans for prolonged services full of surprises

08/01/2022

by: Julia Kyles, CPC

CMS does not intend to adopt the new CPT code for prolonged services in the facility setting, such as hospital inpatient or observation (hospital) services. But, according to the 2023 Medicare physician fee schedule proposed rule, the agency’s proposed alternative contains several twists.

Subsequent hospital fees to rise, office E/M fees to drop in ’23

08/01/2022

by: Richard Scott

Physician practices are facing a 4% cut to the conversion factor in CY 2023, and the fee losses are evident when looking at a list of high-volume procedures and services. For non-facility rates, only two of the nearly two dozen services on this list will see larger payments in the new year, according to a review of data CMS shared as an addendum file to the proposed 2023 Medicare physician fee schedule.

New and revised codes for '23: Relative value unit rundown

07/28/2022

by: Julia Kyles, CPC

Take a look at the new, revised and potentially misvalued services that CMS identified in the proposed 2023 Medicare physician fee schedule. The downloadable document (xls) provides current and projected work relative value units (RVU) for each service, allowing you to compare RVU changes between 2022 and 2023.

CMS accepts the basics for hospital E/M updates, retains 3 home-grown policies

07/25/2022

by: Julia Kyles, CPC

You will continue to juggle two sets of rules for hospital inpatient and observation E/M visits if CMS sticks to plans outlined in the proposed 2023 Medicare physician fee schedule released July 7.

CMS tweaks telehealth rules as 151-day extension remains in place

07/25/2022

by: Julia Kyles, CPC

CMS will add its new prolonged service G codes to the telehealth services list, require modifier 93 for audio-only encounters and increase the originating site fee to $28.61, according to the proposed 2023 Medicare physician fee schedule.

Easing risk, CMS seeks to entice new entrants in Shared Savings program

07/25/2022

by: Roy Edroso

After some troubled years, the Medicare Shared Savings Program (MSSP) is hoping to reverse the trend by giving its members breaks on performance metrics. But CMS also is pushing hard for participants to come up to scratch quickly in two areas: the all-payer measurement model enabled by the electronic clinical quality measures (eCQM)/MIPS CQM reporting method; and health equity.

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