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June 2021


COVID-19 continues to make headlines, and medical practices and critical access hospitals nationwide continue to do their part to keep patients safe and healthy while also renewing their commitment to coding and documentation compliance. This month, we’ve compiled five news stories to help providers stay abreast of industry changes. As we head into July, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. Most importantly, stay safe out there.


Beware: Claims submitted post-March 2020 are now subject to MAC audits

CMS has announced that Medicare Administrative Contractors (MAC) will begin conducting post-payment audits for claims with dates of service on or after March 2020. Providers may be surprised—particularly regarding their telehealth claims—if they haven’t focused on coding and documentation integrity since the beginning of the pandemic. Consider an internal audit to identify ongoing vulnerabilities before your MAC does.


Medicare quarterly provider compliance newsletter targets CPAP therapy, units of drugs and biologicals

Providers are bracing for Comprehensive Error Testing Rate audits of CPAP therapy as well as Recovery Audit Contractor audits of units billed for single-dose vials of drugs and biologicals. For CPAP therapy, focus on documentation integrity to avoid payer recoupments. For drugs and biologicals, know when and how to report the -JW modifier. As always, an internal audit can identify potential problems.


Online reviews—love ‘em or hate ‘em, they influence patient attraction and retention

A majority of today’s tech-savvy patients rely on online reviews when choosing a healthcare provider, yet 20% of these reviews on Google and Yelp may be fake. Unfortunately, patients aren’t necessarily adept at deciphering fact from fiction. Have you looked at online reviews for your own practice as well as reviews of your competitors? What can you do to collect and promote positive reviews of your practice? Marketing your practice is just as important as accurate coding and billing. It’s all part of a larger strategy to remain profitable.


Leveraging AMA’s commitment to health equity and justice in medicine: The time to act is now

The American Medical Association (AMA) recently published its organizational strategic plan to embed racial justice and advance health equity. What are some of the AMA’s goals? Develop tools that enable physicians to use public health epidemiology data to address local patterns of health equity and inequity within cities, equip physicians with the ability to enhance and assess their skills in providing high-quality care for marginalized communities, and much more. In the meantime, what is your practice doing to address health inequities? Sometimes the smallest steps can make the biggest difference.


CMS increases Medicare payments for providers administering at-home COVID-19 vaccines

Providers who administer COVID-19 vaccines at patients’ homes will be pleasantly surprised to know that Medicare has increased payment by an additional $35 per dose. This increases  

the total payment for at-home vaccination from approximately $40 to approximately $75 per dose. If a patient receives a two-dose vaccine, the provider will receive approximately $150. Why is this important? Approximately 1.6 million adults ages 65 and older may have trouble accessing the COVID-19 vaccine because they are homebound. Fifty-one percent of these older adults face at least one additional barrier, such as living alone or lacking technology. Boosting payments incentivizes providers to travel to these access-challenged and hard-to-reach individuals.


About us

Physician Practice Resources, Inc., founded in 2002, headquartered in Midlothian, IL

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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