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July 2021


With COVID-19 variants on the rise, medical practices and rural hospitals nationwide continue to brace for impact—all while striving to ensure high-quality patient care and revenue integrity. This month, we’ve compiled four news stories to help providers stay abreast of industry changes. As we head into the remainder of the summer, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. Most importantly, stay safe out there.

The CY 2022 Physician Fee Schedule Proposed Rule is out: Are you ‘in the know’?

The CY 2022 Physician Fee Schedule Proposed Rule is filled with important information, most notably proposed changes to split/shared evaluation and management (E/M) visits and expanded telehealth coverage for mental and behavioral health. The rule also includes several provisions aimed at bolstering the abilities of rural health clinics and federally-qualified health centers to furnish care to underserved Medicare beneficiaries. There’s a lot of information to unpack, and Physician Practice Resources can help. Reach out to us if you have questions. We have answers.

Beware of the OIG’s focus on transitional care management: Can you ensure revenue integrity?

During a recent audit, the Office of Inspector General (OIG) discovered almost $1.7 million in overpayments associated with 13,577 claims for transitional care management (TCM) services rendered during calendar years 2015 and 2016. The culprit? Multiple physicians billing for TCM services for a beneficiary’s same 30-day TCM service period. Another reason: Restricted overlapping care management services provided during the same 30-day TCM service period for the same beneficiary. What can you do to ensure compliance? Coordinate care with other providers so you know who is billing the TCM service. Also review coding requirements and restrictions with other care management services. There are several codes that physicians cannot bill during the time period covered by TCM. Physician Practice Resources can educate providers on how to document and code TCM services correctly.

When it comes to telehealth, you need a long-term strategy: Are you ready?

Telehealth use is still 38 times higher than pre-pandemic levels, according to one recent study. It’s clear that even as patients return to the office, they’ll likely continue to want the option for telehealth in certain circumstances. Medical practices need to determine how they will provide a hybrid care model. This includes making sure all payer rules are followed now during the public health emergency and beyond. Physician Practice Resources, Inc. can help you sort it all out.

FY 2022 ICD-10-CM official coding guidelines are posted: Have you taken a look?

The Centers for Disease Control and Prevention (CDC) has posted the FY 2022 ICD-10-CM official coding guidelines that go into effect on October 1, 2021. Pay attention to the narrative changes that appear in bold text. This includes instructions for assigning new code U09.9, Post COVID-19 condition (found under section I.C.1/g.1.m), updates that allow coders to capture codes based on documentation from clinicians other than the patient’s provider, and much more.

About us

Physician Practice Resources, Inc., founded in 2002, headquartered in Midlothian, IL is a full-service company that partners with small and large 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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