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CMS is amping up its tech-based coverage policies, and you’ll find a suite of new ways – assessing images, taking phone calls and more – to get paid in 2019 should the proposals get finalized. However, experts caution that some of the glitter may fade when you dive into the details of the services.
A study suggests large practices actually underperform small practices in cost of care and hospital readmissions, but you might redress the balance by engaging independent networks, educating your patients and using your imagination.

A proposed Shared Savings rule pushes risk onto all participants within a few years – and signals more risk in the future for all Medicare providers as well.

With the upcoming vetting of Brett Kavanaugh for the soon-to-be vacant seat of Justice Anthony Kennedy on the U.S. Supreme Court, providers may see a pro-business ally whose past rulings show a skepticism of the power of administrative agencies.
Practices that bill for critical care services (99291-99292) should make sure everyone understands the coding rules for these high-value codes, as well as the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with critical care services. The combination of critical care and modifier 25 is on auditor radar and could trigger denials.


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