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Winners and losers of E/M payment changes: An early look at pay-rate impacts

11/12/2018

When it comes to E/M payments, you’ll enter a business-as-usual cycle on Jan. 1 after CMS opted to delay its proposed sweeping changes for two years. But with a vast array of revisions on the books for 2021, it’s not too early to glimpse the financial outcomes of the single-pay rates and other changes looming ahead.

E/M on the horizon: Payment, coding, documentation changes to come

11/12/2018

by: Richard Scott

Wait for it: CMS cued the music then placed its earth-shifting E/M changes on hold for two years. The earliest that medical practices will have to brace for a raft of payment and documentation revisions is Jan. 1, 2021, according to the final 2019 Medicare physician fee schedule released Nov. 1.

Medicare Advantage benefits expand as more seniors hop aboard

11/05/2018

by: Richard Scott

The unfolding evolution of Medicare Advantage plans is creating a ripple effect on the way medical practices approach their patient encounters, resulting in small to potentially larger changes in ways of conducting business. As more patients flock to the public-private hybrids, practices must grapple with a new array of threats and opportunities.

CMS says new Part B drug plan would drop costs, but drug makers have to play along

11/05/2018

by: Roy Edroso

CMS says its new “International Pricing Index (IPI) model” test will lower prices for patients and increase provider surcharges on those drugs in some parts of the U.S. starting in 2020. But some experts are skeptical the model will work.

Unlock complex eligibility requirements for hepatitis screening, vaccines

11/05/2018

by: Richard Scott

Hone in on hepatitis screening and vaccine codes to ensure you’re meeting patient eligibility requirements and correctly reporting a range of Medicare-covered preventive services.

5 answers to common HIPAA questions asked by patients and practices

11/05/2018

by: Mary Brandt, MBA, RHIA, CHE, CHPS

Question: I work for a large company. I called out one day because my daughter was sick. Do I have to provide a doctor’s note to my employer when I wasn’t the actual patient? I’m not under my employer’s health plan.

If workers’ comp patient comes back, treat him as a ‘new’ patient

11/05/2018

by: Roy Edroso

Question: A patient is seen for an IME (independent medical examination) for a workers’ compensation case. The carrier then decides they want us to treat the patient. Is that next visit a "new patient" or "established patient" visit?

4 of 5 enrollees in Medicare Advantage plans that require prior authorizations

11/05/2018

by: Richard Scott

The growing wave of Medicare Advantage (MA) plans may increase the administrative time your practice spends chasing down prior authorizations, as the bulk of MA patients – about 80% – are in a plan that requires one for at least some services, according to new analysis from Kaiser Family Foundation (KFF).

5 documentation do’s and don’ts: A risk-adjustment coding guide

10/29/2018

by: Richard Scott

You should capture the full range of a patient’s chronic conditions when coding under a risk-adjustment paradigm because your payments, and ultimately your coding compliance, may be affected. Beef up one crucial part of the process — provider documentation — to strengthen your efforts.

As younger doctors head for the exits, use job-sharing, other perks to slow attrition

10/29/2018

by: Roy Edroso

As burnout takes its toll, you may find providers — including those under traditional retirement age — leaving more quickly than you anticipated. Take steps now to smooth their transition and reduce the impact to your patients and your practice’s bottom line.

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