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November 2020

Brought to you by PPR

As COVID-19 cases increase, medical practices and rural health systems continue to grapple with these critical questions: How will the upcoming holidays affect COVID-19 transmission? Is each provider’s surge capacity plan truly capable of handling a worst case scenario? Are providers prepared to triage, test, treat, and educate patients about COVID-19? Once a vaccine becomes available, who will have access, and how can providers distribute it effectively? All of these questions are in addition to: How can providers ensure revenue integrity and avoid auditor scrutiny?

This month, we’ve compiled five news stories to help providers stay abreast of industry changes. As we head into the winter months 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.

OIG audits of telehealth services will soon be underway

It’s no surprise that the Office of Inspector General (OIG) recently announced it will start auditing telehealth services in 2021. Audits will focus on pandemic-related waivers and flexibilities that allowed Medicare beneficiaries to access a wider range of telehealth services without having to travel to a healthcare facility. Given the explosion of telehealth services nationwide, have you audited your telehealth claims to ensure revenue integrity?

While you’re at it, have you also thought about best practices for telehealth heading into the New Year? Experts at Brigham Health in Boston share these tips: Develop criteria for triaging and scheduling patients for in-person vs. virtual visits, optimize telehealth technology to meet provider and patient needs, and design key performance indicators to assess virtual care effectiveness.

AAPC releases free 2021 E/M calculator

To help providers prepare for E/M changes that take effect January 1, 2021, AAPC has provided a free tool that enables users to calculate codes based on time and/or medical decision making. Use this tool to see how new E//M guidelines will affect code assignment and to identify areas for documentation improvement.

Report new CPT codes for coronavirus vaccine products and administration

The American Medical Association (AMA) recently announced the following new CPT codes for coronavirus vaccine products:

  • 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mLdosage, diluent reconstituted, for intramuscular use
  • 91301: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

Also be sure to report these new vaccine administration CPT codes:

  • 0001A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose
  • 0002A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose
  • 0011A: Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose
  • 0012A: Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

According to the AMA, “In accordance with the new vaccine-specific product CPT codes, the CPT Editorial Panel has worked with the Centers for Medicare & Medicaid Services to create new vaccine administration codes that are both distinct to each coronavirus vaccine and the specific dose in the required schedule. This level of specificity is a first for vaccine CPT codes, but offers the ability to track each vaccine dose, even when the vaccine product is not reported (e.g. when the vaccine may be given to the patient for free).”

AHA continues to provide COVID-19 resources for rural healthcare providers

The American Hospital Association (AHA) provides helpful blog posts on rural health as well as inspiring case studies that highlight rural hospital interventions for COVID-19. This comes in the wake of ongoing media reporting that depicts the unique challenges that rural providers face during the pandemic—particularly an inability to transfer patients in need.

Incident-to billing surfaces in new fraud investigation

Several Memphis physicians are on the hook for $340,000 after incorrectly billing incident-to services. In particular, they’re accused of knowingly charging Medicare for services rendered by nurse practitioners at the higher reimbursement rate for physician services when no direct supervision took place. How well do you know incident-to billing requirements? Is it time for an audit to ensure compliance?

About us

Physician Practice Resources, Inc., founded in 2002, headquartered in Matteson, 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. Our core competencies include: Consulting Services, Medical Coding, Temporary Help Services, Professional Management and Development Training, Continuing Education Webinars/Workshops and Coding Exam Preparation and Tutoring. Contact us at https://www.ppr-corp.com/about-ppr-corp/ for more information.

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