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Small practice? Medicare diabetes prevention program might not be for you

08/07/2017

Details on the Medicare version of the diabetes prevention program (MDPP), modified in the proposed physician fee schedule that came out last month and set to kick off in 2018, are still a little sketchy. But some observers already foresee problems for smaller suppliers — and even for physician practices that want to add it as a line of service.

CMS publishes advance copy of new interpretive guidelines to meet EM CoPs

08/07/2017

by: AJ Plunkett

No more excuses for getting ready to meet the new emergency preparedness Conditions of Participation (CoPs). CMS has published an advance copy of the interpretive guidelines for its surveyors and has provided a handy spreadsheet you can customize to show exactly what tags your organization will need to meet by Nov. 15.

Payments reach billions for medically necessary modifier-25 services

08/07/2017

by: Richard Scott

Payments for E/M services appended with modifier 25 (Significant, separately identifiable E/M service) topped $2.5 billion in 2015, according to the latest available Medicare claims data.

Ortho, other specialties can bill CCM but watch the coding fine print

07/31/2017

by: Richard Scott

Question: We've had a request from one of our physicians to report chronic care management (CCM) code 99490 using osteoarthritis as one of the qualifying factors. Has anyone used this in the orthopedic setting? The CCM guidelines mention three conditions that must be met to bill, and I’m wondering if the patient has to meet all three of the criteria and not just some or part of it.

Set your clock to report proposed prolonged preventive service codes

07/31/2017

by: Richard Scott

Get ready to add two new codes to your mix in 2018 and you’ll gain a revenue opportunity when you see patients for a prolonged period during a visit involving one of 19 Medicare-covered preventive services.

You can stop patients recording their visits — but do you want to?

07/31/2017

by: Roy Edroso

Depending on your state laws, you may be able to prevent patients from recording their encounters with your providers — but you might prefer to use the opportunity to educate and build trust with them instead.

Treating veterans? Check for, return overpayments before the VA asks

07/31/2017

by: Marla Durben Hirsch

If your practice provides private health care services to veterans through one of the Veterans Health Administration’s initiatives, heads up: The Veterans Administration (VA) has discovered that a computer error caused it to reimburse private providers at the wrong rate, and it will be retrieving overpayments.

Senate Obamacare repeal efforts fail (Updated)

07/31/2017

by: Roy Edroso

In the early morning hours of Friday, July 28, the Senate voted down the last-ditch "skinny" Obamacare repeal bill 51-49, making three unsuccessful Senate attempts to pass repeal-and/or-replace legislation in a week.

Under QPP, virtual groups not expected to get ancillary services exception

07/31/2017

by: Roy Edroso

Question: In the Quality Payment Program (QPP) proposed rule’s virtual groups section, CMS mentions “self-referral” a few times. Why did that come up?

Proposed prolonged status for these codes is great — but do the basics first

07/31/2017

by: Roy Edroso

CMS’ proposal to let 19 preventive services codes be billed with prolonged service add-on codes is good news to many providers. But it’s only good if they can get those codes accepted in the first place — and some of them have given providers trouble.

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