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Low volume biggest reason for practices to qualify for MIPS exclusion

10/24/2016

Almost half of practices with one to nine clinicians don’t bill enough or see enough Medicare patients to be subject to the merit-based incentive payment system (MIPS) in 2017.

Small price changes make big differences for most-used drugs in October ASP list

10/17/2016

by: Roy Edroso

A penny-per-dose drop in the price of low osmolar contrast material (LOCM) may not sound like much, but to a radiologist who uses it several times a day, and is reimbursed 106% of average sales price (ASP) by Medicare on it, it will have a big impact over time.

PQRS, value modifier informal review may spare you penalties, but act fast

10/17/2016

by: Roy Edroso

You have until Nov. 30 to defend yourself if you think you’ve been scored on the physician quality reporting system (PQRS) or the value modifier (VM) unfairly – and you should report even suspected errors lest you be wrongly penalized by as much as 6%.

Post notices for patients about grievance policy to meet October compliance date

10/17/2016

by: Marla Durben Hirsch

Don’t fall behind a key compliance date for section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age and disability in any health care program or activity.

Navigate screening vs. diagnostic tests to successfully report prostate screens

10/17/2016

by: Richard Scott

Get a handle on the type of prostate cancer screening you’re providing and shore up your diagnosis coding to rein in runaway denials on this common preventive service.

Q4 drug pricing brings mostly mild changes, with a few big gainers, losers

10/17/2016

by: Roy Edroso

What may be the last quarterly average sales price (ASP) update before a final rule changes the way Medicare reimburses providers for hundreds of drugs is out, with some big changes but a mostly level schedule/

Spend time on moderate sedation; stop self-inflicted pay cuts next year

10/10/2016

by: Julia Kyles

Take note if your providers perform moderate sedation as a stand-alone service or in conjunction with procedures that include moderate sedation: Staff must understand the sweeping revamp of moderate sedation policy in the CPT 2017 manual or your revenue from private payers and Medicare will come up short.

Get ready to renegotiate contracts with the basics: Correct out-of-date agreements

10/10/2016

by: Roy Edroso

The road to better rates has to start somewhere: Before you can ask for better terms on your payer contracts, you have to make sure you’ve got the latest versions and that you understand their rates and relative values.

Get organized, negotiate to solve Medicare Advantage pre-authorization problems

10/10/2016

by: Richard Scott

Standardize your workflow to overcome prior-authorization hurdles faced when dealing with the diverse Medicare Advantage (MA) plans on your patient roster. Doing so can save you time and headaches.

New primary care-based psych codes offer opportunity, challenges in 2017

10/10/2016

by: Richard Scott

You could find a new path to payment when you deliver psychiatric services in 2017 given Medicare’s proposed coverage of several primary care-based codes, but you may encounter a hard lift in adopting the Collaborative Care Model (CoCM) upon which the codes are based.

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