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NPPs, other lower-billing specialists see 99214 payments on the rise

01/29/2018

The steady increase of 99214 encounters, which topped 103.6 million visits in 2016, was largely the product of non-physician practitioners (NPPs) and other specialty groups — including hematologists/oncologists, neurologists and urologists — filing more claims, according to a review of historical Medicare claims data.

As value-based wave breaks, 4 options for practices still stuck in fee-for-service

01/22/2018

by: Roy Edroso

Risk-averse practices, heads up: If you haven’t started your transition away from fee for service into value-based reimbursement, look at easy upside-only models to get in the swim or seek shelter in a larger organization.

Discover cost measure formulas and prepare for 2018 scoring impact

01/22/2018

by: Richard Scott

Clear up confusion about the two cost measures impacting your 2018 merit-based incentive payment system (MIPS) performance year by knowing which metrics CMS will use to assess Medicare spending and how many patients may be attributed to your practice.

HHS details new settlement option for providers awaiting hearings at ALJ level

01/22/2018

by: Josh Poltilove

Beginning Feb. 5, home health agencies and other providers with a low volume of pending appeals at the administrative law judge (ALJ) level will have a new option for resolution while avoiding the judges’ massive backlog of appeals.

New bundled payment model gives providers entry to advanced APMs

01/22/2018

by: Richard Scott

You’ll find a new entry into the world of advanced alternative payment models (APM) after CMS announced the Bundled Payments for Care Improvement (BPCI) Advanced program, which will reward providers on the basis of their cost-containment and quality scores for 32 distinct episodes of care.

Denials down on all top codes – and not bad with many others – with modifier 24 in 2016

01/22/2018

by: Roy Edroso

The good news for practices whose providers tend to use modifier 24 (Unrelated E/M, same physician, post-operative) is that the denial rates of the codes most often used with that modifier went down in 2016, the most recent year of available Medicare data.

Modifier 25 payment cuts delayed until March; opposition continues

01/15/2018

by: Richard Scott

Practices in a number of states gained a reprieve from planned cuts to modifier 25-appended claims after Anthem, one of the nation’s largest health insurers, announced it would postpone a policy change that would have cut claims by 25% until March 1.

QPP reporting portal open; report and get preliminary scores – but hurry

01/15/2018

by: Roy Edroso

The data-submission tool for reporting your 2017 Quality Payment Program (QPP) measures, which opened Jan. 2 and will be available through March 31, appears to make it easy to report and even predict your score – but go early to stay on top of possible glitches.

Thousands of providers get GPCI cuts caused by MACRA expiration; payback uncertain

01/15/2018

by: Roy Edroso and Laura Evans, CPC

The 1.0 floor on work geographic practice cost indexes (GPCIs) has expired, which means GPCIs in 52 localities — including the states of Wyoming, Oklahoma and Ohio and municipalities such as Atlanta and St. Louis — will see a significant drop in reimbursement this year. And no one is sure when, or whether, the floor will be put back.

At hearing, Azar open to mandatory bundled programs, drug price deals

01/15/2018

by: Roy Edroso

Though generally evasive at his hearing before the Senate Finance Committee on Jan. 9, Health and Human Services Secretary nominee Alex Azar did reveal certain policy preferences — some expected, such as a preference for state over federal control of Medicaid, and some less so, such as an openness to mandatory bundled payment programs.

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