EXPERT Contributors this issue

Antonio Arias, MBA, CHBME, with NCG Medical.

As an experienced EMR and insurance billing provider for dermatology practices, Antonio, and the medical billing experts at NCG Medical, can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your dermatology practice grow, rather than worrying about insurance billing. www.ncgmedical.com

Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS. As CEO and Board Chair of the American Institute of Healthcare Compliance (AIHC), Joanne brings over 35 years of clinical and executive healthcare experience in areas of compliance, coding, documentation improvement, auditing, privacy, security, consulting, and administration. www.aihc-assn.org

Daniel Lebovic, ESQ, Corporate Counsel and Technical Content Manager, Compliancy Group. Mr. Lebovic has 15+ years of regulatory compliance and contract management experience. His background makes him uniquely able to translate HIPAA regulations into content that those without legal knowledge can easily understand. https:// compliancy-group.com

Trevor McElhaney, JD, Consulting Advisory, is the Associate Director of Consulting at the firm’s Knoxville, Tennessee office. His focus areas include feasibility studies for potential ventures, practice startups, strategic planning for growth-stage practices, transactional advisory, and succession planning. His extensive knowledge and experience across primary care and specialty practices allow him to structure each engagement to the individual needs and goals of each client. https://www.doctorsmanagement.com

Eric McGuire, SVP of Coding, AGS Health. At AGS Health, we help you streamline your revenue cycle so you’re free to invest in your organization and its goals. www.agshealth.com

Rachel V. Rose, JD, MBA, is an Attorney at Law, in Houston, TX. Rachel advises clients on healthcare, cybersecurity, securities law, and qui tam matters. She also teaches bioethics at Baylor College of

Medicine. She has been consecutively named by Houstonia Magazine as a Top Lawyer (Healthcare) and to the National Women Trial Lawyer’s Top 25. She can be reached at rvrose@rvrose.com. www. rvrose.com

Erin Stephens, CPC, CIRCC, Sr. Client Manager, Education for Healthcare Administrative Partners. HAP is a revenue cycle management company for medical facilities, with over two decades of experience serving physician practices in a variety of settings and medical specialties. www.hapusa.com

Randi Tapio, MBA, CMRS, CPCS, CHM, CHBP, founded MedCycle Solutions, creating revenue cycle solutions for healthcare practices that will improve efficiencies, maximize reimbursements, and help clients get paid faster. Randi is an experienced healthcare revenue cycle professional with more than 20 years of experience in various healthcare roles, including revenue cycle, administration, and consulting. As an experienced revenue consultant, she has a long history of cultivating strong working relationships with providers, ancillary staff, and healthcare executives. Randi concentrates her efforts in working with independent and hospital-based physician groups to improve revenue by increasing productivity and office efficiency, as well as billing and coding compliance. www.medcyclesolutions.com/

Natalie Tornese, CPC, is a Senior Group Manager responsible for Practice and Revenue Cycle Management at MOS. She brings 25 years of healthcare management experience to the company. Natalie has worked in varied leadership roles with practices and specialties. Her primary focus is revenue cycle management with an emphasis on Medical Billing, Coding, and Insurance Verification Management. She has written numerous articles on all aspects of Practice Management and presently manages a large team focused on Medical Billing, Medical Coding, Verification, and Authorization services for MOS. Contact us at 1-800-670-2809 or visit us at www.outsourcestrategies.com.

Steve Verno, CMBSI, CHCSI, CEMCS, CMSCS, CPM, CHM, is a Professor of Medical Coding and Billing Instruction at Florida Metropolitan University. We are always interested in hearing from any industry experts who would like to

Final CY 2023 Physician Fee Schedule Fact Sheet

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released their final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS had previously released their proposed version on July 7, 2022. After receiving submitted feedback from the public during the comment period, CMS published the final version that, unless otherwise stated, will have policies going into effect January 1, 2023. Much of what was proposed in July remains in this final version.

Download: https://www.billing-coding.com/pdf/FINAL-2023-MEDICARE-PHYSICIAN-FEE-SCHEDULE.pdf

Reconsideration and Appeal Submissions Going Digital

In 2023, our work to replace paper with digital tools will shift to eliminating paper you send to us. This change:

- Eliminates postal delays, lost mail, and processing time for UnitedHealthcare to receive and scan the documents into our system - May make it easier for healthcare professionals to meet reconsideration and appeal timely filing deadlines by eliminating mail times

As a result, beginning Feb. 1, 2023, you’ll be required to submit claim reconsiderations and post-service appeals electronically. This change affects most* network health care professionals (primary and ancillary) and facilities that provide services to commercial and UnitedHealthcare® Medicare Advantage plan members. This does not affect pre-service clinical appeals.

UnitedHealthcare Provider Portal: Reconsiderations and Appeals interactive guide - https://chameleoncloud.io/review/6828-637e3e1787120/prod

Source: uhcprovider

New Data Shows Telehealth Usage Drops by 4% Nationally

The latest Fair Health data shows that telehealth usage fell by around 4 percent nationally in October 2022, making up 5.2 percent of all medical claim lines.

Amid the ongoing COVID-19 pandemic, the Fair Health Monthly Telehealth Regional tracker reported that telehealth use fell nationally and in every U.S. census region last October, except usage in the Northeast.

The FAIR Health Monthly Telehealth Regional tracker is a complimentary service that analyzes the changes associated with telehealth usage monthly by tracking various factors such as claim lines, procedure codes, and diagnostic categories. The population represented is privately insured and includes Medicare Advantage but excludes Medicare Fee-for-Service and Medicaid beneficiaries.

Throughout the COVID-19 pandemic, telehealth use increased sharply, largely due to the barriers restricting in-person care.

In January 2022, for example, when cases resulting from the Omicron variant spiked, there was a significant increase in telehealth use in every U.S. census region. Nationally, there was a 10.2 percent increase in telehealth utilization, which resulted in telehealth visits representing 5.4 percent of all medical claim lines.

However, in October 2022, telehealth use fell after three months of relative stability. Its share of medical claim lines also decreased compared to the month prior. Nationally, telehealth use dropped 3.7 percent, from 5.4 percent of medical claim lines in September to 5.2 percent in October.

At the regional level, there was also a decline in telehealth use. In the South, Midwest, and West, telehealth use rates declined by 6.8 percent, 4.9 percent, and 4.1 percent, respectively. In the Northeast, however, telehealth utilization saw a 1.7 percent increase.

Regarding diagnoses, there were various changes to note in October 2022. At the national level and in most regions, COVID-19 diagnoses fell, like the month prior.

Source: mhealthintelligence

Medicare Updates IVIG Demonstration Payment for 2023

Healthcare providers submitting claims for services, supplies, and accessories ordered under the Medicare Intravenous Immune Globulin (IVIG) Demonstration can expect to see an approximate 2.1 percent payment increase over last year. The calendar year 2023 rate for HCPCS Level II code Q2052 is $392.56, compared with $384.59 in 2022.

Source: AAPC

Firearm Intent Discrepancies Found In Revenue Cycle Discharge Data

Coded firearm data is playing a larger role for hospitals and health systems as many are placing an emphasis on firearm education and social determinants of health capture.

Unfortunately, a retrospective medical record review recently published in JAMA Network Open is showing a gap in this data.

The study found that 28% of intentional firearm injuries resulting in emergency department admissions were inaccurately coded as accidents. An expert panel recently characterized this coding problem as a glaring gap in the U.S. firearms data infrastructure, the study said.

They reviewed 1,227 medical records for patients who presented to the emergency department with a firearm injury of any severity between October 1, 2015, and December 31, 2019. Researchers determined that 837 (68.2%) reviewed cases were intentional assaults, but of these assaults, 234 (28%) were coded as unintentional injuries in hospital discharge data.

Source: healthleadersmedia

CMS Issues 2% MA Rate Hike for 2024

Medicare Advantage plan rates will increase by 2.09% next year, largely in line with analyst expectations but likely lower than payers had hoped.

The 2024 Medicare Advantage and Part D Advance Notice released recently also includes some technical changes to the risk adjustment model, such as using ICD-10 codes instead of ICD-9, making it more up to date and more predictable, said CMS Deputy Administrator and Director of the Center for Medicare Meena Seshamani in a recent call with reporters.

The rule comes on the heels of regulation opposed by payers that would begin retroactive plan audits in an attempt to claw back overpayments. Payer lobby AHIP said that the proposal, the Risk Adjustment Data Validation, or RADV rule, was “fatally flawed.”

Stocks of payers tied to the MA market, like Humana, UnitedHealthcare and Elevance, all trended down closely after.

Source: healthcaredive

Lifetime Guarantee Program

Price rise is due to increasing costs that we are all familiar with. We held out as long as we could, but we’ve had to raise the price for a 12-month subscription to $89.95.

We will honor our commitment through our Lifetime Guarantee program and uphold those prices for qualified subscribers. We appreciate your loyalty to us!

To learn more about this program, visit: billing-coding.com/lifetime.cfm