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May 2021

Change. It’s the only constant in life. It’s also the ‘only constant’ in the healthcare industry. When regulations evolve, compliance challenges and questions typically follow. This month, we’ve compiled five news stories to help providers stay abreast of industry changes. As we head into June, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. Most importantly, stay safe out there.


Confused about telehealth coverage? Check out these resources.

In the absence of federal telehealth coverage, many states have been moving forward with expanded access. Arizona, for example, now requires all health insurance companies to expand telemedicine coverage for all services that would normally be covered for an in-person visit. This resource from the Center for Connected Health Policy helps practices understand parity laws for telehealth. It distinguishes between two types of parity requirements: Coverage or service parity (i.e., the same services must be covered via telehealth just as they would be covered if delivered in-person) and payment parity (i.e., a requirement for the same payment rate or amount to be reimbursed via telehealth as would be if it had been delivered in-person). The good news is that a recent bipartisan bill seeks permanent Medicare coverage of audio-only telehealth after the COVID-19 public health emergency concludes.


Behavioral health integration (BHI): Will your practice jump on board?

The connection between physical and mental health has always been clear. What hasn’t always been clear is how primary care physicians can integrate behavioral health services into their already busy workflows—and get paid for the services they provide. It’s definitely possible, and one physician in rural North Carolina recently discussed how she currently works with onsite licensed mental health professionals as well as a couple of independent counselors to provide behavioral health support for her patients. In addition, she provides medication for addiction treatment (MAT) services. Want to learn more about how to get started with BHI? Check out the American Medical Association’s BHI Compendium. Be sure to review Chapter 11 on billing and coding for financial sustainability.


Administering COVID-19 vaccines? Heed the OIG’s warning.

If your medical practice administers COVID-19 vaccines, the Office of Inspector General (OIG) has a few words of wisdom to share:

  • Don’t charge any out-of-pocket costs or balance bill the patient when administering the COVID-19 vaccine. The practice may, however, seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees.
  • Don’t deny vaccination based on a patient’s coverage or network status.
  • Don’t charge an office visit or other fee if the sole purpose of the visit is to obtain the COVID-19 vaccine.
  • Don’t require the patient to have additional medical services to receive the COVID-19 vaccine.


Apparently, the OIG has received patient complaints regarding charges for the COVID-19 vaccine. Don’t let your practice get caught up in noncompliant billing practices.


Struggling to keep your practice’s doors open? Focus on coding compliance, digital health.

Fewer than 50% of physicians are in independent medical practices, according to recent AMA data. For some, it’s simply too difficult to stay profitable. Perhaps they don’t have a handle on denial management, meaning their cashflow is riddled with bottlenecks. Perhaps they haven’t evolved to embrace digital health, meaning their patients have sought care elsewhere. Perhaps their coded data reflects poor care quality. There could be countless other reasons as well. Fortunately, medical practices that focus on coding compliance are much more equipped to weather the storms of change. Embracing digital health such as telehealth and remote patient monitoring are equally as important and can actually help physicians be successful under value-based payment programs.


Sharing notes with patients? It’s not as scary as you think.

Primary and specialty care clinicians agree that sharing notes with patients online is beneficial overall, according to a new study. That’s good news because a new federal rule requires to make their notes and a variety of other information automatically available to patients for free. The rule took effect April 5, 2021. Here are some questions for practices to consider: First, is your practice in compliance with this rule? Second, does your practice have a procedure in place to handle patient questions that arise? This includes requests for amendments to their medical record. Third, is your practice using this requirement to its advantage—i.e., to better engage patients in their own health?

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Physician Practice Resource improves operational effectiveness through documentation integrity across the entire revenue cycle.  Contact us at https://www.ppr-corp.com/about-ppr-corp/ for more information.



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