Beyond Face Time v 2.0: The OIG Awakens

For most of the history of Medicare, reimbursement has only been available for services where the physician directly interacts with the patient.  As the emphasis on value became stronger, it became necessary to allow payment for services between visits or procedures through with physicians manage their patients’ care. In 2016, Alice first wrote about this but today there are multiple additional codes. These are services which can benefit physicians, but the OIG has also begun to pay attention to them. In “Beyond Face Time v 2.0: The OIG Awakens”  Alice first addresses traditional forms of non-face time services such as incident to, split/shared visits and care plan oversight and then moves through the more modern services of transitional care management, chronic care management, remote physiologic monitoring and concluding with the 2025 new service of advanced primary care management. She explains the details of what each requires, describes relevant OIG activity, and proffers where physicians are likely to fail in documenting and billing effectively.  Also addressing Supreme Court cases, she opines that as the gradual shift to more value-based payments has mandated more coordination of care, these services represent a potential benefit to pay physicians for what they actually do; but they also present a real risk area for them.