Expect compliance hotspots, G2211 boom, telehealth ‘super bowl’ and more

Why This Topic Matters

The article highlights areas where practices may face audit, recoupment, or documentation scrutiny, while also pointing to new or expanding billing opportunities and policy changes that could affect revenue and operations. It is relevant for organizations preparing for payer, Medicare, and telehealth-related updates in 2024.

Article Sections

1. 2024 predictions

   Introduces the article’s annual outlook and the broad categories of compliance, reimbursement, and telehealth developments expected to matter in 2024.

2. Prediction: Investigators and prosecutors will come after telehealth fraud, remote patient monitoring (RPM), speaker programs and COVID fraud.

   Discusses anticipated enforcement attention around telehealth-related activity, remote monitoring arrangements, COVID-era claims, and other fraud-focused investigations.

3. Expect RPM activity too

   Covers expected scrutiny of remote monitoring arrangements and the role of government alerts and payer review in this area.

4. COVID claims comeback

   Reviews possible continued pursuit of pandemic-era claims and funding issues, including matters that may surface after being under seal or after delayed investigations.

5. Other possible compliance hits

   Summarizes additional enforcement and compliance pressure points involving managed care, payer denials, and speaker-related arrangements.

6. Prediction: Add-on visit complexity code G2211 will surpass the 38% utilization rate that CMS predicted for 2024 — and reach 100 million claims.

   Examines expected adoption of the new visit-complexity add-on and the factors shaping provider interest, specialty uptake, and reporting patterns.

7. Prediction: 2024 will be the year of the telehealth “super bowl.”

   Covers the major telehealth policy deadlines, waiver expirations, and legislative and regulatory actions expected to dominate the year.

8. Prediction: CMS will urge SDOH risk assessment, practices will look for guidance.

   Looks at social determinants of health screening and the anticipated interest from practices in payer and CMS guidance.

9. Prediction: No big leap, but a smooth rise in prior authorization reform.

   Discusses ongoing prior authorization reform efforts, related Medicare Advantage requirements, and broader payer interoperability trends.

10. Prediction: Revised split/shared rules will create compliance pitfalls.

    Addresses compliance concerns tied to team-based E/M billing and the ongoing evolution of split/shared policy.

11. Prediction: Behavioral health treatment will rise — but lack of Medicaid, provider uptake may clip its wings.

    Covers behavioral health reimbursement changes, new provider participation, and the practical barriers that may limit uptake.

12. Resources

    Lists external references and source materials cited at the end of the article.