We’ve upgraded our events calendar. Stop by the new Insights events calendar to find upcoming complimentary live webinars, workshops, and conferences – both virtual and in-person throughout the year.
ST. PAUL, MN – Panacea Healthcare Solutions, Inc., a company specializing in healthcare coding compliance, revenue integrity, and pricing software and consulting services, is proud to be a virtual co-sponsor of the 26th Annual Health Care Compliance Association (HCCA) Conference on March 28 – 31 in Phoenix, AZ and online.
Government agency audits and payer strategies are evolving fast, and healthcare organizations must be ready to mitigate risk and exposure while making the most of revenue opportunities. With the recent regulations surrounding CMS Price Transparency and the No Surprises Act requiring Good Faith Estimates, Compliance teams are further impacted.
Panacea will demonstrate its new proprietary auditing technology platform which can audit 100% of claims or coding abstract data, allowing the ability to focus time and investment on only the problem areas for under or over coding while revealing missing revenue opportunities. Attendees can request a demonstration by visiting Panacea’s virtual booth.
“We’re excited to show HCCA conference attendees how Panacea’s nationally recognized consultants can provide auditing services using our proprietary auditing technology for Inpatient and Outpatient Auditing and Compliance, Physician Auditing and Compliance (Professional Services) and specialty areas,” said Kathy Pride, Executive Vice President, Coding and Documentation of Panacea.
Pride continued, “If you have internal auditors, they’ll certainly value the speed, accuracy and agility of running 100% of your data to apply coding documentation, compliance and/or lost revenue rules found in our library – along with the flexibility to write their own custom rules – to identify the biggest opportunities for improvement in your documentation, coding, data integrity and payment levels.”
To learn about how Panacea can help your audit program become more comprehensive, effective, cost efficient and compliant, call us at (866) 926-5933 or visit our website at www.panaceainc.com/nobody-audit-like-we-do-overview/
About Panacea Healthcare Solutions, Inc., a BESLER Company
Panacea helps healthcare organizations improve their coding, compliance, and revenue integrity with front-line expertise in mid-revenue cycle management through innovative auditing, compliance, chargemaster, strategic pricing, and revenue integrity consulting and software solutions that allow clients to proactively identify risks and opportunities and overcome today’s challenges. More information is available at panaceainc.com.
Compliance and auditing offer an opportunity for continuous improvement. Done right they help organizations better serve patients, mitigate risk and exposure, and improve reimbursement and revenue. But what constitutes doing it right? This article discusses the three most common mistakes.
A large, multi-specialty practice with more than 1,000 physicians and allied health professionals has been able to achieve significant efficiencies by consolidating a number of core administrative activities, particularly billing, reimbursement, and other financial operations.
The 2022 Final Rule defines split (or shared) visits as evaluation and management (E&M) visits in the facility setting that are performed in part by both the physician and a non-physician practitioner (NPP) who are in the same group, in accordance with applicable laws and regulations. Additionally, split/shared visits are further defined as those that:
CMS has stated that limiting split/shared visits to institutional settings only, for which “incident to” payment is not available, would allow for improved clarity and clearly distinguish the policies applicable to such visits from the policies applicable to services furnished incident to the professional services of a physician. CMS further explained that they did not see a need to allow split/shared visit billing in the office setting, because the “incident to” regulations govern situations in which an NPP works with a physician who bills for the visit.
“Physician practices have been billing for split/shared visits in the office setting for many years now,” said Kathy Pride, Panacea Healthcare Solutions Executive Vice President for Coding and Documentation Services. “Most providers are focusing on patient care and do not necessarily read the billing regulations on a regular basis and may not be aware that the split/shared visit is no longer allowed in the office setting.”
CMS is also now including certain skilled nursing facility/nursing facility E&M visits under this definition, and for critical care, which were previously excluded from split/shared billing.
The practitioner who bills for the split/shared visit should be the practitioner who performs the substantive portion of the visit. The “substantive portion” is defined as “more than half of the total time spent by the physician and NPP performing the split/shared visit.” However, CMS is allowing one transitional year (2022) to include in the definition, noting that “the substantive portion of the visit can also be defined as one of the three key components (history, exam, or medical decision-making/MDM).” It is important to note that starting Jan. 1, 2023, time will be the sole basis for split/shared visits, and the substantive portion will be defined as “more than half of the total time.”
CMS also clarified that when one of the three key aforementioned components is used as the substantive portion in 2022, the practitioner who bills the visit must perform that component in its entirety. CMS has also clarified that only one of the practitioners must have a face-to-face (in-person) contact with the patient, but it does not necessarily have to be the practitioner who performs the substantive portion and bills for the visit. The substantive portion could be entirely with or without direct patient contact, and will be determined by the proportion of total time, not whether the time involves direct or in-person patient contact.
“A lot of the times, the guideline changes are slow to be adopted, due to the fact that the physicians are not getting the information in timely fashion,” Pride added. “Therefore, it is important that the compliance and coding leadership/education teams get the word out to the providers that the rules have changed.”