Part B News | Editors' Blog

CMS extends enforcement discretion on No Surprises Act 'convening provider' rule indefinitely

by: Roy Edroso Dec 6, 2022

Just a few weeks after closing out a Request for Information on its No Surprises Act (NSA) rules, CMS has given anxious providers an early holiday gift: An extension of its enforcement discretion on the convening provider requirements that are part of the Good Faith Estimates (GFE) providers must create for patients.

AMA Q&A session reveals substantive confusion over split/shared guidelines

by: Julia Kyles, CPC Nov 17, 2022

Make sure billers, coders, clinicians and compliance staff understand that the substantive portion rule does not apply to CPT split/shared coding guidelines.

Breaking: CMS finalizes 4.5% rate cut in ’23, confirms E/M trajectory in Medicare PFS

by: DecisionHealth Staff Nov 1, 2022

Start your look-ahead to CY 2023: Payment cuts are coming, significant changes to E/M services are finalized and key reporting revisions are hitting telehealth and audio-only services, according to the final 2023 Medicare physician fee schedule released today.

Proposed payment cuts that drew vocal criticism from physician advocacy groups will move forward as planned, as CMS announced a 4.5% reduction to the CY 2023 Medicare Part B conversion factor (CF), effective Jan. 1.

HHS announces 2% payment lift on biosimilars

by: Roy Edroso Oct 3, 2022

Per the terms of the Inflation Reduction Act (IRA) signed into law Aug, 16, the payment for biosimilar drugs under Part B average sales price (ASP) reimbursement ticks up from 106% – the cost of the biosimilar plus a 6% provider reimbursement – to 108% starting this month.

Who can solve the mystery of the missing level 1 visits?

by: Julia Kyles, CPC Sep 21, 2022

Missing: More than 300,000 services that had been reported with 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.)

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