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September 2021


COVID-19 continues to be top of mind for everyone. However, today’s busy practice managers must also focus on reducing denials, improving cashflow, and ensuring revenue integrity. What a crazy time to work in the healthcare industry—particularly in a rural setting or physician practice. The pressure feels enormous sometimes. The good news is that there are resources that can help, PPR being one of them. This month, we’ve compiled five news stories to help providers stay abreast of industry changes. 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.

FY 2022 CPT codes are out. Have you reviewed them?

Eight new Category 1 CPT codes for COVID-19 vaccine administration are among 405 editorial changes in the 2022 CPT code set. The changes, which take effect January 1, 2022, include a total of 249 new codes, 63, deletions, and 93 revisions. Of note are five new CPT codes (i.e., 98975, 98976, 98977, 98980, 98981) to report therapeutic remote monitoring as well as four new codes (i.e., 99424, 99425, 99426, 99427) for principal care management. Also notable is a new appendix that provides a taxonomy for digital medicine services. This appendix supports increased awareness and understanding of new approaches to patient care and how to best reflect those approaches using appropriate CPT codes.

American Rescue Plan (ARP) helps providers who serve rural patients. Have you read up on it?

The Department of Health and Human Services (HHS) recently announced there will be $8.5 billion available for providers who serve rural patients. The goal of the ARP is to help address the disproportionate impact that COVID-19 has had on rural communities and rural healthcare providers. The amount given will be based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy-defined rural areas. Eligible rural providers have the opportunity to simultaneously be considered for both Phase 4 of the Provider Relief Fund as well as ARP Rural payments.

OIG: Think you can ignore modifiers -25 and -59? Think again.

A Florida ophthalmology clinic found itself under the Office of Inspector General’s (OIG) microscope after being paid $2.1 million for services inappropriate billed as being distinct or significant and separately identifiable from other services provided on the same day. Specifically, the inappropriate payments related to other services performed on the same day as eye injections of Avastin, Eylea, and Lucentis. Practices must have policies and procedures in place to make sure they do not bill for services that are not separately payable from these intravitreal injections and that they only bill for services that are reasonable and necessary.

Open Notes mandate is in full swing. Has your practice seen an increase in medical record corrections?

Medical practices have been complying with the Open Notes mandate since April 5, 2021, and in some practices, the impact has been larger than in others. In particular, patients may be quick to identify errors and express an interest in correcting them. This article does a great job of summarizing challenges and opportunities. For example, practices must identify a process for record amendments and patient education; however, greater patient engagement can also potentially lead to improved outcomes and enhanced care coordination.

DOJ announces major telemedicine fraud. How will you ensure compliance?

The Department of Justice recently announced criminal charges against more than 43 criminal defendants for their alleged participation in fraud schemes using telemedicine. The schemes resulted in more than $1.1 billion in false and fraudulent claims. Although most providers don’t intentionally commit fraud, many may unknowingly submit inaccurate claims because they don’t understand the rules and regulations. Now is the time to consider performing an internal audit or hiring an external auditor to validate coding and documentation integrity.

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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