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Massive settlement shows OIG will pursue established patient upcoding

07/10/2017

Two medical centers in Massachusetts will pay more than $700,000 to settle allegations that they upcoded claims when they failed to follow the rules for new and established patients.

As MIPS ‘one and done’ becomes ‘some and done,’ watch reporting details

07/10/2017

by: Roy Edroso

One and done — the ability to report one measure for the merit-based incentive payment system (MIPS) and avoid the penalty — is over. Now MIPS is “some and done” for providers who want to beat the 2020 payment penalty in the 2018 performance year. Plan carefully to cover the point spread.

Proposed 2018 MIPS scoring: Do the math to be prepared

07/10/2017

by: Roy Edroso

MIPS scoring as described in the 2018 Quality Payment Program (QPP) proposed rule has a lot of moving parts. It helps to focus on the basic math of calculating a score, then factor in the bits and pieces that complicate it.

MIPS complex patient bonus may be coming your way in 2020 payment year

07/10/2017

by: Laura Evans

If your Medicare patients include those with multiple comorbidities, you likely are eligible for a new complex patient bonus CMS is proposing to debut next year.

Use a checklist to overcome denials for core debridement codes

07/10/2017

by: Richard Scott

Implement a self-auditing tool with information about depth, size, location and other documentation specifics to ensure your claims for debridement codes 11042-11047 don’t get rejected.

eClinicalWorks’ fraud settlement includes obligations to users

07/10/2017

by: Marla Durben Hirsch

The eClinicalWorks (ECW) $155 million fraud settlement will have a major impact on all users of electronic health records (EHRs), not just those using ECW software. Here’s what you need to know and what decisions you need to make.

Practices find more success with debridement-related denial rate

07/10/2017

by: Richard Scott

Practices trimmed their denial rates associated with a suite of six debridement codes that they billed more than 3 million times in 2015, which is the latest year of available Medicare claims data.

Locum tenens is not the answer when a physician passes away

07/03/2017

by: Roy Edroso

Question: May a locum tenens doctor fill in for a deceased doctor?

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