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March 2021

COVID-19 vaccines are well underway, but that doesn’t necessarily mean we’re in the clear. Physician practices and rural hospitals continue to feel long-term effects of the pandemic on their finances and operations. This month, we’ve compiled five news stories to help providers stay abreast of industry changes. As we wrap up the first quarter of the year, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. Most importantly, stay safe out there.

Check out technical corrections to the new E/M guidelines

The American Medical Association (AMA) recently issued technical corrections to the new E/M guidelines to provide updates in a number of key areas, including the following:

  • · Reporting a test that is considered, but not selected
  • · Definition of ‘analyzed’
  • · Clarification of ‘unique test’
  • · Clarification of ‘discussion’ (between physicians, other qualified health care professionals, and patients)
  • · Definitions of minor, major, elective, and emergency surgery
  • · Activities not included in time when reporting as key component for code selection

Note that these changes are highlighted in blue. Be sure to review them and share with physicians as well.

Consider a refresher on how to bill Medicare as a secondary payer

That’s because CMS recently published a Medlearn Matters article on this topic, indicating that it has probably seen some noncompliance in this area. More specifically, when another insurer is the primary payer, bill that insurer first. After receiving the primary payer remittance advice, bill Medicare as the secondary payer, if appropriate.

This Medlearn Matters article also reminds providers to collect full beneficiary health insurance information upon each office visit, outpatient visit, and hospital admission. The article also provides guidance on what to do if Medicare inappropriately denies a claim. According to the article, CMS admits that it has inappropriately denied L, NF, or WC MSP claims when services are not related to the accident or injury identified on the beneficiary’s Medicare record.

Explore the link between social determinants and COVID-19 outcomes

Social determinants matter when it comes to health outcomes, including COVID-19 deaths. That’s what a recent report by McKinsey & Company found. More specifically, the report states that four challenges may drive the disproportionate effect of the pandemic in rural areas: health status, socioeconomic vulnerability, access to care, and health behaviors.

These are just a few potential solutions: Shifting providers from regions with lower relative COVID-19 pressure, cross-training and upskilling personnel to fill critical roles, increasing ancillary support for frontline workers, leveraging telemedicine, organizing hub-and-spoke support models for rural providers to consult with specialists at larger hospitals, and establishing partnerships between rural and urban hospitals for clinically appropriate transfers in certain circumstances.

What’s another piece of the puzzle? Coded data—specifically codes for social determinants of health—that can help us better understand and address the specific challenges faced by rural populations.

Be prepared for ongoing telehealth scrutiny

The Office of Inspector General (OIG) continues to look more closely at telehealth services, and this article nicely summarizes some of its current projects. Accurate medical coding based on complete and thorough physician documentation is paramount. Pay attention to payer-specific requirements, modifiers, and place of service codes.

Rural hospitals: Focus on accurate coding to combat ongoing financial struggles

A new OIG report indicates that COVID-19 has worsened longstanding challenges regarding staffing, limited capacity, and finances at rural hospitals. These hospitals face countless challenges with limited solutions. One strategy, however, is to focus on accurate and complete coding. Like all hospitals, rural hospitals must ensure they capture all of the revenue to which they’re entitled.

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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