December 2020

Providers nationwide continue to struggle with rising cases of COVID-19 all while trying to prepare for widespread distribution of vaccines recently approved by the FDA. It’s a lot to manage on top of everyday pressures to generate and capture revenue. This month, we’ve compiled five news stories to help providers stay abreast of industry changes. As we head into 2021, 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 publishes its FY 2021 Physician Fee Schedule Final Rule

Effective January 1, 2021, this final rule addresses remote physiologic monitoring (RPM), telehealth services, principal care management, and more. Following are some notable changes:

1. Providers can bill HCPCS code G2252 for a virtual check-in that includes 11- 20 minutes of medical discussion if the service does not originate from a related E/M service in the previous 7 days or leads to a related E/M service or procedure within 24 hours or soonest available appointment.
2. When the public health emergency ends, CMS will again require RPM services be furnished only to established patients.
3. Providers can bill CPT code 99439 (non-complex chronic care management services) concurrently with transitional care management.
4. The following services will be permanently added to the Medicare Telehealth Services List: Visit complexity inherent to certain office/outpatient E/M services (HCPCS G2211); prolonged services (HCPCS G2212); cognitive assessment and care planning services (CPT 99483); psychological and neuropsychological testing (CPT 96121); home visits for established patients (CPT 99347- 99348); domiciliary, rest home, or custodial care services for established patients (CPT 99334 – 99335); and group psychotherapy (CPT 90853).
5. CMS defines a medical device supplied to a patient as part of RPM services as one defined by Section 201(h) of the Federal Food, Drug, and Cosmetic Act. In particular, the device must be reliable and valid, and that the data must be electronically (i.e., automatically) collected and transmitted rather than self-reported.
6. CMS added two new HCPCS codes, G2064 and G2065, to the general care management HCPCS code, G0511, for principal care services furnished in rural health clinics and federally-qualified health centers beginning January 1, 2021.

Take the time to review these and other changes to ensure compliant coding and billing in the year ahead.

Devise a plan to educate patients about the COVID-19 vaccine

The CDC has published various resources to help physicians explain the importance of COVID-19 vaccination. Various other resources are also available online. For example, the American Academy of Family Physicians has published helpful information. Practices can also create a page on their website devoted specifically to vaccine-related questions. Here’s an example.

Stay on top of COVID-19 coding changes

Be sure to check out this COVID-19 billing FAQ last updated on December 16, 2020 as well as this list of CPT codes, effective dates, and payment allowances for various COVID-19 vaccines, monoclonal antibodies, and administration. Also note that CMS is covering monoclonal antibody therapies at no cost for patients in a broad range of settings. In addition, there are six new ICD-10-CM codes for COVID-19-related conditions. These codes take effect January 1, 2021.

HHS proposes important changes to HIPAA

A recent proposed rule outlines various HIPAA-related changes, including the requirement for covered entities to respond to requests for information within 15 days (instead of 30). If finalized, it would also require transparency regarding estimated fee schedules for access and disclosures, permission for individuals to view their protected health information (PHI) in person (including being able to take notes or use other personal resources to view and capture images of their PHI), and more. It behooves practices to review the rule and determine potential impact.

HHS proposes to streamline prior authorization

According to a recent proposed rule, payers would need to render authorization-related decisions with 72 hours. This rule also includes a lot of additional information about payer-to-payer data exchange, accelerating the adoption of standards for social risk data, and much more. Again, take the time to review this rule and familiarize yourself with potential changes.

 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.