August 10, 2020

by Sean Weiss, Partner & VP of Compliance Telehealth has played a critical role during the Public Health Emergency (PHE). CMS proposed changes expanding telehealth services permanently. The proposed rule implements an effort to reduce the burden under the Patients Over Paperwork initiative and ensures appropriate reimbursement for time spent with patients. In 2021, changes to increase payment for office/outpatient E/M visits take affect. These higher payments take into account changes in the practice of medicine and the additional resources required to take care of patients of which, two-thirds (2/3) have multiple chronic conditions and, as of 2018, 68.9% of beneficiaries have 2 or more chronic conditions. Between 2014 and 2018, the percentage of beneficiaries with 6 or more chronic conditions grew from 14.3% to 17.7%.
As part of the Patients over Paperwork initiative, CMS is proposing permanent changes following the PHE:

  1. NPs, CNSs, PAs, and CNMs can supervise diagnostic tests consistent with state law and licensure
  2. Pharmacists can provide services as part of the professional services of a practitioner
  3. PTAs and OTAs can provide maintenance therapy in outpatient settings
  4. PT and OT, speech-language pathologists, and other clinicians who directly bill Medicare are to review and verify, rather than re-document information

What to do next…

  1. If you need help with an audit appeal or regulatory compliance concern, contact us at (800) 635-4040 or via email at [email protected].
  2. Read more about our: Total Compliance Solution

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Experienced compliance professionals. Our compliance services are structured by a chief compliance officer and supported by a team that includes physicians, attorneys and a team of experienced auditors. The team has many decades of combined experience helping protect the interests of physicians and the organizations they serve.
Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credentials.
Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.
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