2021 Physician Fee Schedule Final Rule – Prolonged Services

by Barbara J Cobuzzi The 2021 Physician Fee Schedule Final Rule was published by CMS on Tuesday December 1, 2020. (https://www.cms.gov/files/document/12120-pfs-final-rule.pdf) There were not many surprises since we had the Proposed Rule to review during the late summer/early fall. But one new item was introduced as part of the 2021 Outpatient E&M Documentation changes that was not expected and that was the introduction of CMS code G2212, “Prolonged office or other outpatient evaluation and management service(s) beyond maximum required time of the primary procedure which as been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional with or without direct patient contact (list separately in addition to CPT codes 99205 or 99215 for office or other outpatient evaluation and management services)”. G2212 replaces AMA CPT code 99417 for Medicare Part B patients. The AMA description of 99417, “Prolonged office or other outpatient evaluation and management service(s) beyond minimum required time of the primary procedure which as been selected using total time requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each additional 15 minutes of total time (list separately in addition to CPT codes 99205 or 99215 for office or other outpatient evaluation and management services)” Comparing the definitions of G2212 and 99417 it appears at first blush, that they are they are the same. But in reality, one word difference in the two definitions is what sets them apart and… Read More

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OIG Expects to Recover $5.9B in Healthcare Fraud

The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup a… For more, read here: AAPC Blog Related Posts:Millennials and Their Healthcare AccessHealthcare Job Growth Greatest in 2018Michigan Surgeon Accused of $60M Billing FraudAnthem Investigator Charged with Fraud

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OIG Uncovers Medicare Overpayments for Chronic Care Management Services

Chronic care management (CCM) services are services that do not involve face-to-face patient/provider contact. The Centers for Medicare & Medicaid Services (CMS) implemented Medicare coverage for CCM in Jan. 1, 2015. There are very specific guid… For more, read here: AAPC Blog Related Posts:Is Direct Primary Care the Answer?Requirements for Reporting Allergy Services Are…Medicare Part D Prescription Drug Model to Change in 2020Prevent Medicare Claims Denials in 2020Bundled Payments Reduce Care CostAppeals Backlog Gone in 4 Years: Medicare

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Pharmaceutical Compounding Chapter Revisions on Hold

But for how long, nobody knows. allergy, otolaryngology and primary care practices can breathe a sigh of relief, as the new Compounding Pharmacy USP standards set to go into effect Dec. 1, 2019, have been postponed as a result of appeals. The revision… For more, read here: AAPC Blog Related Posts:Get More Involved with Your Local AAPC Chapter

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2 Tips for Billing a Physician Assistant as Assistant Surgeon

A physician assistant (PA) serves as an assistant surgeon only to suture and close an incision. There is no documentation that the PA performed any other function to assist the primary surgeon during the surgery performed on the Medicare patient, suc… For more, read here: AAPC Blog Related Posts:2021 Physician Fee Schedule Final Rule – Prolonged ServicesHMA Pays $260 M for False Billing and KickbacksBilling 95165 Is Nothing to Sneeze AtIncident-to Billing May Be EliminatedAssistant at Surgery Modifiers Require Specific…Cyber Threats to Physician Practices Are Growing

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Reporting Bilateral Services: Conflicting Information Causes Confusion

Payer-specific rules — especially rules that vary for every claim — not only make collecting revenue difficult, but also add to the cost of collection of monies earned by the physicians. A blog clarifies Novitas’ instructions for reporting modifier … For more, read here: AAPC Blog Related Posts:OIG Uncovers Medicare Overpayments for Chronic Care…2021 Physician Fee Schedule Final Rule – Prolonged ServicesCompliance ServicesRequirements for Reporting Allergy Services Are…CMS Proposes Add-on Codes for E/M ServicesSpeaking Services

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Michigan Surgeon Accused of $60M Billing Fraud

Bay City, Michigan surgeon Vasso Godiali, MD, was indicted on July 10, 2019, for allegedly orchestrating a $60 million healthcare fraud scheme. He is also charged with money laundering for financial transactions involving almost $50 million in proceed… For more, read here: AAPC Blog Related Posts:Billing 95165 Is Nothing to Sneeze AtHMA Pays $260 M for False Billing and KickbacksOIG Expects to Recover $5.9B in Healthcare FraudAnthem Investigator Charged with FraudIncident-to Billing May Be Eliminated2 Tips for Billing a Physician Assistant as…

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Cyber Threats to Physician Practices Are Growing

Here’s how to fight back. Most of us are concerned about being personally attacked by cybercriminals, and we must have that same increased awareness within our medical practices. Cybercriminals consider medical practices ripe for the picking. Security For more, read here: AAPC Blog Related Posts:E/M: 2019 Proposed Physician Fee Schedule – Next Steps2 Tips for Billing a Physician Assistant as…2021 Physician Fee Schedule Final Rule – Prolonged Services

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