Are AI Scribe Notes Triggering Medicare Advantage Denials in Primary Care?

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AI scribes are becoming increasingly common in primary care practices. By capturing conversations and converting them into clinical notes, these tools can reduce documentation time and help physicians spend more time with patients. But faster documentation does not automatically mean cleaner claims. If AI-generated notes do not accurately reflect the services provided, important clinical details are missing, or the final note does not support the codes submitted, Medicare Advantage claims may face additional scrutiny, denials, or payment delays. For primary care practices, the goal should not be to avoid AI scribes. It is to make sure AI-assisted documentation is reviewed and supports accurate coding and billing. How AI Scribe Notes Can Affect Claims AI scribes generate documentation from conversations between providers and patients. The output may include the patient's history, assessment, plan, and other clinical details. However, an AI-generated note can contain omissions, inacc...
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Expanding Medicare Telehealth Use after PHE

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CY 2023 Medicare Physician Fee Schedule Proposed Rule

On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This calendar year (CY) 2023 PFS proposed a rule that made lots of provisions including expanding Medicare telehealth use even after the end of a public health emergency (PHE).

Expanding Medicare Telehealth Use after PHE

For the calendar year 2023, CMS is proposing a number of policies related to Medicare telehealth services including making several services that are temporarily available as telehealth services for the PHE available through CY 2023 on a Category III basis, which will allow more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list. CMS is proposing to extend the duration of time that services are temporarily included on the telehealth services list during the PHE, but are not included on a Category I, II, or III bases for a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022).

CMS is proposing to implement the telehealth provisions in the CAA, 2022 via program instruction or other sub-regulatory guidance to ensure a smooth transition after the end of the PHE. These policies extend certain flexibilities in place during the PHE for 151 days after the PHE ends, such as 

  • allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, 
  • allowing certain services to be furnished via audio-only telecommunications systems, and 
  • allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services. 

To learn more about Expanding Medicare Telehealth Use after PHE, click here: https://bit.ly/46fYgsF Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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