Category: Business
2021 E/M Coding, Billing, and Auditing Toolkit 12/9/20
Getting paid for some of the most routine outpatient office visits becomes a new challenge on January 1st, when guideline and code descriptor changes for E/M services — previously announced by
the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) – take effect.
Visit the Ink file called “The Business End” to access “MGMA’s 2021 E/M Coding, Billing and Auditing Toolkit”
- Outpatient Office Visit E-M Codes, Preparing for 2021 – On Demand Webinar
- 2021 Medical Decision Making for Outpatient E-M Codes
- Preparing Your Practice for 2021 E-M Changes
- Medical Decision Making for Outpatient E-M Codes
- 2021 Medicare Physician E-M Fee Schedule Analyzer Tool (Non-facility).
- MGMA-2021-Final-Rule-EM-Fee-Schedule-Analyzer-Tool
- 2021 Medicare Physician Fee Schedule (PFS) Tool (Non-Facility)
- MGMA-2021-Final-Fee-Schedule-NonFacility-V1
- 2021 Medicare Physician Fee Schedule (PFS) Tool (Facility)
- MGMA-2021-Final-Fee-Schedule-Facility-V1
- 2021 E-M Outpatient Office Visit Codes FAQ
- 2021 E-M Audit Worksheet
- 2021-EM-Audit-Worksheet
- 2021 E-M Coding Quick Reference
- 2021-EM-Quick-Reference
I Am Going to File A Complaint!!!!
Now you do! POET has scoured the Universe. We have compiled information on how to file a complaint, with just about anybody you might want to file a compliant with. The OIG, TDI, BBB, CMS, TRS, ERS, Texas School Board, State Employees, Federal Employees, CHIPS, Self Funded Employee Groups, TMHP, Tricare, the Attorney General… Check it out, downloaded it, get out your pen….
Aetna OfficeLink Updates Published 12/1/2020
For new and updated information on:
- Changes to Aetna’s National Precertification List (NPL)
- Surgical procedures performed in the ER, modifier 54, rate change
- Beginning March 1, 2021 you may see new claim edits. These will be part of Aetna’s 3rd Party Claim and Code Review Program.
- Individual Service Codes are being assigned to Service Groups (a lot of changes are coming)
- Changes in Commercial and Medicare Drug list
- Changes in Prior Authorization Requirements
TMA’s Reimbursement Specialist Want You to Know
About These Items That Are Listed in the UnitedHealthCare December Bulletin:
- Starting January 1, UHC will follow the revised 2021 E&M coding and guideline changes for the AMA and CMS.
- January 1, for Medicare Advantage plans, UHC will expand prior authorization requirements and site-of-service medical necessity reviews.
- And, UHC has delayed implementation of its Laboratory Test Registry protocol
New coding guidelines a recipe for improved revenue 11/20/2020
Bill Dacey, MHA, MBA, CPC-I is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, documentation and compliance concerns for physicians.
36 Guidelines to Evaluate a Practice Management
Need to know where to begin:
- Financial Management – Billing and Collections
- Financial Management – General
- Personnel Management
- Marketing and Practice Promotion
- Self Development
- Leadership Skills
Optimizing Advanced Practice Providers
MGMA, October 2020
The COVID-19 pandemic has amplified the previously growing importance of advanced practice providers (APPs) in care delivery and practice performance.
Increasing demands for healthcare point to a projected physician shortage, estimated to reach between 54,100 and 139,000 physicians by 2033.1 One strategy to address this shortage is to close gaps in primary care access through increased use of APPs. One estimate points to expanded use of nurse practitioners (NPs) could reduce primary care physician (PCP) shortages by 70%.2
Many practices already recognize the substantial boost that APPs can provide to practice performance, with APP utilization growing. MGMA data show that almost 67% of Better Performer practices employ APPs; for physician-owned practices, that rate jumps to
almost 87%.3
Cigna Online Appeals and Claim Reconsideration 11/9/2020
Now you can submit appeals and claim reconsideration requests online for medical claims using the Cigna for Health Care Professionals website (CignaforHCP.com). This is an enhancement you’ve been asking for and we’ve been working hard to provide you with an easy-to-use tool
Ransomware Threat Targeting HealthCare Providers. 11/09/2020
You can’t afford to continue to look the other way.
SOME GREAT TIPS TO SHARE WITH YOUR STAFF.
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Open in new tab HEIGHTENED RANSOMWARE THREAT: ACTION STEPS
MGMA members-the federal government has announced a heightened risk of malware/ransomware attacks on the healthcare industry-including physician practices and inpatient facilities. We wanted to identify some actions you can take to reduce your risk and resources to assist you.
Actions to reduce your risk:
- Discuss the issue of cybersecurity with your IT/website vendor and have them block known sites that provide known functionality to the malware (reference the IOC list below)
- Have your IT/website vendor monitor endpoint detection on servers and workstations for changes in applications and running services
- Have your IT/website vendor monitor all new account creations. Especially critical are those with administrator access
- Have your IT/website vendor confirm that your data backup systems are in place and working effectively. Remember that offsite data storage is preferable
- Ensure your practice’s business continuity and disaster recovery plans are up-to-date and readily available
- Discuss the heightened threat with your administrative and clinical staff and the increased need to stay highly diligent during this time
- Consider instituting a practice-wide policy prohibiting staff use of personal email accounts as a method to decrease your risk
- Remind staff not to open emails and/or attachments from unknown senders (and even be cautious with attachments from recognized senders)
- Encourage staff to inform you regarding any suspicious email or cyber incident
Resources:
HHS Bulletin: us-cert.cisa.gov/sites/default/files/publications/…
IOC List: gist.github.com/aaronst/…
MGMA member-benefit Cybersecurity Action Steps
Robert Tennant MA
Director of Health Information Technology Policy MGMA Government Affairs
Washington DC
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