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November 2021

As we head into the Thanksgiving holiday, there’s so much to appreciate. For those of us working in the healthcare industry, we’re able to play a critical role during the COVID-19 pandemic. Whether you work in a small physician practice, a rural hospital, or any other type of care setting, you can have a positive impact through accurate data reporting.


Still, healthcare is also a dynamic and demanding industry with changes coming at us left and right. This month, we’ve compiled five news stories to help providers stay abreast of industry developments. 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.


CMS released its CY 2022 hospital OPPS final rule. Are you ‘in the know?’

CMS recently released its CY 2022 hospital OPPS final rule, and it’s not good news for hospitals that haven’t complied with price transparency requirements. In particular, CMS is setting a minimum civil monetary penalty of $300 per day for hospitals with 30 or fewer beds and a penalty of $10 per bed per day for hospitals with more than 30 beds. The agency has capped the maximum daily dollar amount at $5,500. This means a full calendar year of noncompliance could cost a minimum of $109,500 per hospital and a maximum of $2,007,500 per hospital.


Other changes on the way? CMS will halt the elimination of the inpatient-only list. It will also nearly double Medicare Part B payment rates for certain vaccines, including influenza, pneumonia, and hepatitis B. CMS is also updating the clinical labor rates used to calculate practice expenses under the Physician Fee Schedule for the first time in nearly two decades.


Be sure to review the rule and prepare for changes that take effect January 1, 2022.


Prior authorizations continue to plague medical practices. What’s your plan to improve the process?

Prior authorizations top of the list burdensome issues for today’s medical practices, according to MGMA’s 2021 annual regulatory burden report. Eighty-eight percent of practices say prior authorizations are ‘very’ or ‘extremely’ burdensome. Also at the top of the list? COVID-19 workplace mandates, the Medicare quality payment program, and COVID-19 Provider Relief Fund reporting requirements. What steps is your practice taking to address these challenges so they don’t ultimately have a negative impact on patient care?


Note new codes for COVID-19 vaccination status. Are you prepared for changes coming April 1, 2022?

Effective April 1, 2022, coders can report three new ICD-10-CM codes for vaccination status (i.e., Z 28.310 [unvaccinated for COVID-19], Z28.311 [partially vaccinated for COVID-19], and Z28.39 [other underimmunization status]) as well as the following seven new ICD-10-PCS codes for COVID-19 therapeutics and vaccines:


  1. XW013V7 (Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7)
  2. XW013W7 (Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7)
  3. XW023V7 (Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous approach, new technology group 7)
  4. XW023W7 (Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7)
  5. XW0DXR7 (Introduction of fostamatinib into mouth and pharynx, external approach, new technology group 7)
  6. XW0G7R7 (Introduction of fostamatinib into upper GI, via natural or artificial opening, new technology group 7)
  7. XW0H7R7 Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7)


Educate coders on these changes so they’re ready to go when the April 1 go-live date is here.


Medical practices continue to struggle with denials. Is yours one of them?  

Duplicate claims. Patient isn’t eligible for services. Services are bundled. Most of today’s medical practices experience denials for a whole host of reasons. The key is knowing which denials are most common at your own practice and implementing safeguards to prevent them from occurring in the first place. Might an audit be in order? We can help.


Addressing social determinants of health doesn’t need to be hard. Have you tapped into resources?

The American Medical Association (AMA) provides a social determinants of health (SDOH) toolkit that can help practices identify different tools available to screen patients and connect them with appropriate resources. Coded data is a critical part of any SDOH strategy. Want to learn more? Contact us.


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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