Many new trends are emerging in medical billing, including the rapid adoption of healthcare billing technology and the shift to virtual payments.
FREMONT, CA: Hospitals and healthcare organizations, many of which are still coping with massive financial losses and staffing shortages caused by the COVID-19 pandemic, are under intense pressure to maximize revenue and reduce compliance risks. Below are the top trends impacting medical billing and compliance in the coming year.
Fee schedule revisions: From telehealth services to shared E/M visits, the 2022 Medicare Physician Fee Schedule (PFS), finalized by the Centers for Medicare and Medicaid Services (CMS) on November 2, contains numerous significant changes.
Accessible provisions are essential in light of the ongoing pandemic. CMS has extended reimbursement for the Medicare telehealth services list adopted in response to the COVID-19 public health emergency (PHE) until the end of 2023.
Aspects of the PFS on reimbursement for telehealth mental health services may prove less straightforward. Patients with mental health disorders can receive telehealth services via audio-only communication technology in certain circumstances. But only when delivered by providers who could give two-way, audio/video technology, but instead used audio-only technology due to the patient's preference or technical limitations. It is necessary to use a new modifier to attest to this capability.
Medications will also need to be modified for split E/M visits, provided by a physician and non-physician practitioner (NPP) in a facility setting. Physicians and nurses who give the substantive portion of the visit must submit the payment. For 2022, CMS has defined "substantive" as more than fifty percent of the time spent on history, physical exams, and medical decision-making. Over fifty percent of the total time will be sufficient by 2023.
Prepayment evaluations: Private insurers are anticipated to follow Medicare's lead and rely more heavily on prepayment reviews to identify improper provider reimbursements before payments are made.
