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New Primary Cares model gives PCPs easy road to value-based pay starting in January

04/29/2019

HHS and CMS officials announced on April 22 a new, voluntary demonstration model for primary care providers that would introduce value-based payment as a partial (or in some cases complete) substitute for fee-for-service with varying levels of involvement and risk, to begin as soon as January 2020.

Anthem rolls out modifier 25 policy that could deny same-diagnosis E/M claims

04/29/2019

by: Richard Scott

Beware, reporters of modifier 25-appended E/M services: Anthem, one of the nation’s largest payers, has issued a policy update seeking to curtail claims for E/M codes submitted with the oft-used modifier for significant, separately identifiable E/M services.

CMS gives radiation therapy providers a break — but bigger changes may be coming

04/29/2019

by: Roy Edroso

CMS is letting radiation oncologists bill some E/Ms with superficial radiation therapy (SRT) that had previously been bundled. But those providers should look out: this may be a preliminary step before CMS puts in new regulations that may shake up their reimbursement.

Avoid denials with more specific diagnosis, documentation of anemia

04/29/2019

by: Joel Moorhead, M.D.

Providers tend to complain when they document a diagnosis of “anemia” and then receive a query from a payer requesting a more specific diagnosis. Such a query often causes frustration and yields a response like “anemia not otherwise specified” or “unable to determine.” To avoid queries for non-specific anemia diagnoses, brush up on documentation and coding requirements for different types of anemia in ICD-10-CM.

Radiation treatment codes decline in use in rocky regulatory environment

04/29/2019

by: Roy Edroso

Utilization of 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day) has been skyrocketing in recent years but CMS’ other radiation treatment codes have been going the other way.

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