News and Intelligence

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 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),


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...

April 12, 2019

Emergency medicine physicians are trained to assess patients and make split-second, life-saving decisions, but documenting and coding those encounters can be complex, tedious and time-consuming. Because the relative value units (RVUs) for critical care services are high, the financial implications for physicians and their employers are significant. High RVUs also attract increased scrutiny from pa...

April 1, 2019

Practicefirst’s March client memo referred to the important revisions that CMS has made to Evaluation and Management

Documentation Guidelines, which are effective January 1, 2019.

** Please note the correction to the third bullet below. The requirement should not include the physical exam. We apologize for the miscommunication. 

Highlights of CMS’s revisions include the following:

  • The re...

March 12, 2019

Practicefirst would like to remind its clients about the important

revisions that CMS has made to Evaluation and Management Documentation Guidelines, which are effective January 1, 2019.

Highlights of the changes include the following:

  • The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.

  • For established patient office/outpatie...

February 6, 2019

Practicefirst would like to like to remind its clients about the correct usage of modifier 57, Decision for Surgery. This modifier at first glance looks easy to code, but is often used incorrectly and has made it to the list of open issues for the Recovery Audit Contractors (RAC).

A few items to remember when using modifier 57:

  • This modifier is used only on the E/M codes and not on the procedure...

February 1, 2019

When aspiring medical professionals dream of their future careers, it’s unlikely that they consider the critical role that documentation plays in the healthcare process. Once in practice, providers quickly realize that documentation has a direct impact on their financial success. In addition to the complexity of documentation rules and requirements, the advent of electronic medical records (EMRs)...

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