PBN’s 2024 predictions: Hit on COVID fraud, SDOH push; some still pending

Why This Topic Matters

The piece helps coding and compliance professionals understand which policy and enforcement trends gained traction in 2024 and which remained unsettled. It is useful for monitoring areas that may affect documentation, claims reporting, audit risk, and practice operations.

Article Sections

1. Telehealth and fraud enforcement

   Reviews the year’s enforcement activity tied to telehealth, remote monitoring, speaker programs, and pandemic-related fraud, including federal investigations and prosecutions.

2. SDOH risk assessment guidance

   Summarizes CMS promotion of social determinants of health initiatives and the surrounding guidance outreach for practices and beneficiaries.

3. Prior authorization reform

   Covers federal and state activity affecting prior authorization processes and related payer programs.

4. Behavioral health treatment

   Assesses whether policy changes led to increased use of behavioral and mental health services and notes remaining uncertainty.

5. Add-on visit complexity reporting

   Discusses reporting trends and guidance issues associated with a Medicare add-on visit complexity service during 2024.

6. Split/shared rules

   Highlights compliance concerns created by differences in guidance and the need to review reporting requirements carefully.