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Focus on medical-decision making, time may newly define E/M services

07/24/2017

You may find significant changes to E/M reporting in the near future, including a pivot away from two key elements — history and physical exam — that largely determine a given level of service for your most common patient encounters.

CMS previews preventive service add-on codes, dozens of new CPT codes

07/24/2017

by: Julia Kyles, CPC

Providers who believe the time spent on preventive services far exceeds the revenue they receive should take note: CMS intends to create add-on codes that will allow providers to report and be reimbursed for some preventive services that last at least 30 minutes longer than the typical time.

Diabetes Prevention Program may start April 1 with laxer recognition rules

07/24/2017

by: Roy Edroso

Most of the proposed changes to a program allowing non-provider “coaches” to bill Medicare for educating pre-diabetics should encourage entrants — especially one making participation in the program quicker and easier. But potential suppliers who hoped to do it all online may be disappointed.

CMS intends to lower the bar for the final year of PQRS participation

07/24/2017

by: Julia Kyles, CPC and Richard Scott

This could be excellent news for clinicians who were facing a pay cut because of their physician quality reporting system (PQRS) performance in 2016: CMS has a two-fold plan to ease the transition from quality reporting to quality payment. The plan involves lower reporting requirements and thresholds for avoiding the value-based modifier payment.

CMS gives you time to get to know 5 new patient relationship modifiers

07/24/2017

by: Julia Kyles, CPC

Continuous and broad or episodic and focused. Those are two definitions of a provider-patient relationship. Next year, CMS intends to give doctors and some non-physician practitioners the opportunity to test drive modifiers that indicate the relationship.

Changes to patient assignment, primary care services in Shared Savings Program

07/24/2017

by: Roy Edroso

Check out a variety of changes CMS plans to make to the Shared Savings Program in the proposed 2018 Medicare physician fee schedule.

Some provider-based outpatient departments could see facility rates cut in half

07/24/2017

by: Laura Evans, CPC

CMS is proposing to set payments for certain services performed by non-exempt off-campus provider-based hospital outpatient departments at 25% of the hospital outpatient prospective payment rate next year, down from 50% this year.

Payment, policy and coding proposals from the 2018 physician fee schedule proposed rule

07/24/2017

by: Part B News staff

There’s a lot going on in the 815-page rule. We’ve explored the big stories in this issue. Check out a round-up of other, easy-to-miss changes worth noting.

Revised health bill scuttled as more Republican senators voice opposition

07/24/2017

by: John Commins with additional reporting by Richard Scott and Roy Edroso

Senate Republicans unveiled their revised plan July 13 to repeal and replace the Affordable Care Act (ACA) in a version that scrapped a tax cut for the wealthy, increased subsidies for individual coverage, dropped the individual mandate and allowed insurers to offer no-frills plans.

11 specialty groups set for pay boost in 2018; 23 may see cuts

07/24/2017

by: Richard Scott with additional reporting by Laura Evans, CPC

Clinical social workers, psychologists and podiatrists are among 11 specialty groups slated to receive additional payments for their services in 2018, according to projected allowed charges contained in the proposed 2018 Medicare physician fee schedule.

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