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Don’t bill incident-to when NPPs make plan-of-care decisions

10/30/2017

Question: If a patient is being seen by a non-physician practitioner (NPP) for something like follow-up of sleep apnea and the NPP adjusts the settings of the continuous positive airway pressure (CPAP) device, could the encounter be billed incident to? The provider specifically documented “adjust CPAP setting as needed” in the initial note that established the plan of care.

Physician Compare to offer more scores – and more vulnerabilities for your practice

10/30/2017

by: Roy Edroso

Here’s a reason to care about your providers’ data on Physician Compare, your information for which can be previewed now through Dec. 1: CMS wants to put more of their data there and that will wind up on other, better-attended sites..

Check PQRS, value modifier scores to assess, possibly dispute, 2018 payments

10/30/2017

by: Richard Scott

Don’t forget about the quality-reporting programs of yesteryear just yet; you may face penalties under the physician quality reporting system (PQRS) and value modifier — of up to 4% — in 2018 for your performance during 2016, but you have until Dec. 1 to dispute your results.

Murray-Alexander bill seeks return of CSR payments, but it may already be doomed

10/30/2017

by: Roy Edroso

A Senate bill seeks to restore the cost-sharing reduction (CSR) payments that President Donald Trump stripped from the Affordable Care Act (ACA) — but Trump’s erratic response, not to mention Congressional leadership politics, make its passage extremely difficult. The result: A 20% boost to Obamacare premiums are more likely than not.

Let your PQRS, value modifier scores guide you to early success under MIPS

10/30/2017

by: Richard Scott

Even if you’ve avoided a pay cut under the value modifier program for payment year 2018, don’t disregard your practice-specific quality resource and use report (QRUR). The details inside about your cost performance may steer you to success under the merit-based incentive payment system (MIPS).

Cost-category field testing underway for eligible providers.

10/30/2017

by: Richard Scott

Practices that want to catch a glimpse of how the merit-based incentive payment system’s (MIPS) cost category will work in future years are eligible to participate in a CMS field-testing program

Slight uptick in reimbursement for top codes in 2016

10/30/2017

by: Roy Edroso

It looks like things were a little bit better for providers in 2016 than in 2015 as they got more reimbursement with fewer denials.

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