News and Intelligence

May 1, 2020

If you have received the HHS Stimulus Payment (approximately 4/10/20 for most providers) be aware of the requirement to visit the portal pursuant to the instructions you received and make your attestation. Before attesting, please contact Practicefirst if you would like us to provide you with your 2019 Medicare fee-for-service revenue for your records.

Also, HHS distributing additional $20 billion...

April 7, 2020

     Practicefirst would like to share with you information posted on the National Government Services (NGS) website regarding Amendment of Medical Records.

  • Amendments, Corrections and Delayed Entries in Medical Documentation.

     Occasionally, certain entries related to services provided are not properly documented and need to be amended, corrected or entered after rendering the s...

March 4, 2020

Univera Healthcare

Practicefirst was recently notified by Univera of the following administrative policy effective May 15, 2020, to define the billing and reimbursement guidelines for increased procedural services (i.e., modifier 22) billed on professional claims. This policy is in line with the Centers for Medicare & Medicaid Services and CPT guidelines.

The new policy will apply to all practitione...

February 5, 2020

Practicefirst would like to notify our clients of important changes in the office/outpatient E/M visits effective Jan 1, 2021. Initially CMS had proposed to bring in a reduction in the payment variation for office/outpatient E/M visit levels by paying a single rate (also referred to as a blended rate) for levels 2 through 4 while maintaining the payment rate for level 5. However, as noted in the f...

December 30, 2019

Practicefirst was recently notified by Univera of a new administrative policy effective March 15, 2020, to define the coverage and billing guidelines for preventive services billed on the same day as a problem-oriented visit by the same individual provider for the same member. This policy is in line with the Centers for Medicare & Medicaid Services and Current Procedural Terminology (CPT) guidelin...

December 30, 2019

Practicefirst would like to notify our clients of important changes as outlined by CMS for CY 2020 regarding Medical Record Documentation.

As per CMS MLN Matters MM11560:

Medical Record Documentation:

CMS is finalizing, for CY 2020, a proposal to reduce burden by implementing a broadened general principle beyond teaching physicians that will allow:

  1. All physicians,

  2. Physician Assistants (PA’s),

    ...

November 8, 2019

Practicefirst has been notified that Univera will be introducing a new electronic authorization tool to replace the current tool, Clear Coverage. 

“CareAdvance Provider”, a web-based real time software tool is tentatively scheduled to launch sometime in the fourth quarter of 2019 , beginning with Medicaid Managed Care, Child Health Plus and HARP lines of business.  The  Commercial and Medicare line...

September 26, 2019

Practicefirst would like to notify our clients about a NCCI update that is effective July 1, 2019. National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits consist of column one and column two codes.

If a PTP edit has a CCMI (Correct Coding Modifier Indicator) of "1", the PTP edit shall be bypassed if submitted with an NCCI-associated modifier. Modifiers 59, XE, XS, XP, and XU a...

September 3, 2019

Medicare fraud costs the United States government hundreds of millions of dollars each year. CMS works with other government agencies and law enforcement organizations to protect the Medicare Program from fraud and abuse. Zone Program Integrity Contractors (ZPIC’s) and Unified Program Integrity Contractors (UPIC’s) investigate instances of suspected fraud, waste and abuse.

Their primary goals inclu...

April 12, 2019

With an understanding of the definition of critical care from Part 1 of this series, What Constitutes Critical Care?below are essential documentation and coding guidelines for Emergency Management physicians to ensure they receive the reimbursement they deserve.

Critical care is a time-based service and must be documented as the time the provider spent evaluating, providing care and managing the...

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Amherst, NY 14228

866.234.5017 (Toll-free)

info@pracfirst.com

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