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April 2022

Professional Coding Corner 

Brought to you by PPR 

 

Like always, it has been a busy news month with lots of updates for practice managers, medical coders, and others to understand. It’s always challenging to stay on top of important changes, which is why we’ve compiled five newsworthy stories this month. As we look ahead, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. Most importantly, stay safe out there.  

 

Healthcare fraud: What you need to know 

Stories of healthcare fraud, many of them involving medical practices, seem to make the news on a regular basis. Here are some recent ones: An orthopedic surgeon was indicted by a federal grand jury for his role in a fraud scheme for upcoding over a four-year period. An internal medicine practice was ordered to pay more than $286,000 to resolve claims it billed for medical services not provided. A physician group was ordered to pay $24.5 million to settle allegations it violated the False Claims Act and made a false statement in connection with a loan obtained through the SBA’s PPP. A gynecologist oncologist agreed to pay $775,000 to resolve claims he violated the False Claims Act related to submitting false claims for medically unnecessary surgical procedures. What is your medical practice doing to ensure compliance? 

 

Telehealth: Focus on compliance  

Want to focus on telehealth compliance, but not sure where to begin? Consider starting with these new resources from the OIG. Be sure to check out the Work Plan items as well as Medicare requirements for billing telehealth. In addition, rural health clinics and federally qualified health centers should definitely check out this Medlearn Matters article about mental health visits provided via telehealth. With payer audits of all kinds on the rise, telehealth will likely be a target. Now is the time to focus on compliant coding and billing. While you’re at it, strive to improve your telehealth etiquette with this resource from the AMA. Another helpful tip? Consider asking a medical assistant to begin the telehealth visit. One recent study found that medical assistant-supported virtual rooming supports better connection rates for video visits.  

 

Remote patient monitoring: Use this AMA playbook to get started 

If your medical practice is considering remote patient monitoring, this playbook from the AMA can answer common questions and set you up for a successful implementation. The playbook provides guidance on selecting a vendor, contracting, workflow design, scaling your efforts, and much more. Don’t forget that accurate coding, billing, and documentation are also paramount. 

 

No Surprises Act: Stay up to date on new resources 

The No Surprises Act took effect January 1, 2022, and now CMS has provided an updated FAQ that can help providers maintain compliance. In addition, the AMA has provided a guide on how providers can dispute out of network payments using the No Surprises Act independent dispute resolution process. Be on the lookout for new and emerging resources in the future.  

 

Medical bill collections: HHS may ask your medical practice for data 

As part of its efforts to lessen the burden of medical deb and increase consumer protection, HHS recently announced it will request data from more than 2,000 providers on medical bill collection practices, lawsuits against patients, financial assistance, financial product offerings, and 3rd party contracting or debt buying practices. The goal? To evaluate how providers’ billing practices impact access and affordability of care and the accrual of medical debt. This announcement comes in the wake of three large credit reporting agencies—Equifax, Experian, and Transunion—declaring they will no longer include certain forms of medical debt on credit reports, removing billions of dollars in debt from consumer reports.  

 

About us 

Physician Practice Resources, Inc., founded in 2002 and headquartered in Midlothian, IL, is a full-service company that partners with small and large healthcare organizations to build solutions that enhance operational effectiveness, improve clinical documentation, and decrease overall compliance related risks. Contact us at https://www.ppr-corp.com/about-ppr-corp/ for more information. 

 

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