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Watch out if you’re in a bundled service plan; most don’t fit the APM mold

05/09/2016

Some clinicians may think that because they are participants in a bundled services model they will be automatically exempted from merit-based incentive payment system (MIPS) requirements. However, for most clinicians, that will not be the case, CMS states in the proposed MIPS rule released April 27.

MIPS proposed rule: Measures, eligibility and more will affect your practice

05/09/2016

by: Julia Kyles and Laura Evans

Check out this round-up of important pieces of the merit-based incentive payment system (MIPS) proposed rule released April 27.

APM criteria under MIPS

05/09/2016

by: Laura Evans

Involved in a bundled payment program? See if it qualifies as an APM.

Quality reporting without results heavily reported but may be doomed by MIPS

05/09/2016

by: Roy Edroso and Julia Kyles

The new proposed rule on merit-based incentive payment system (MIPS) reporting suggests that the old physician quality reporting system (PQRS) loophole of reporting “action not performed” with modifier 8P will no longer fly — even though data shows many providers have gotten used to it.

In scenario where patient moves from ER to outpatient surgery, split the bill

05/02/2016

by: Roy Edroso

Question: A patient is seen in a hospital emergency room for an orthopedic issue (E/M code 99284). In the ER, an orthopedic surgeon is called in to evaluate and he decides to operate – yet the patient hasn't been admitted as an inpatient. How should this be billed?

Don’t hold too tightly to departing providers’ patient lists

05/02/2016

by: Roy Edroso

Treating patient lists as a “trade secret” that doctors can’t take with them when they leave may lead to legal challenges and expensive settlements; instead try crafting contract language that gives departing providers, your practice and your patients what they need.

Use checklists, probing questions to boost providers’, patients’ use of ACP

05/02/2016

by: Roy Edroso

Many providers have trouble initiating and engaging in advance care planning (ACP) discussions with their patients — and sometimes vice versa. But simple techniques and guidelines can help both parties buy in for improved care and increased practice revenue.

Choose frequently performed services for your cross-cutting measure to ace PQRS

05/02/2016

by: Richard Scott

Focus on your high-volume activities that you have a penchant for performing well to choose the best cross-cutting measure for your physician quality reporting system (PQRS) submissions in 2016.

PQRS reporting rates increase yet penalties hit thousands of providers

05/02/2016

by: Richard Scott

A majority of eligible providers (EPs) — 62.2% — successfully participated in the physician quality reporting system (PQRS) in 2014, avoiding a 2% pay cut for 2016 Medicare fee schedule rates. Yet that leaves hundreds of thousands of providers who are being hit with a 2% cut this year.

Don’t expect a payment for IV chemotherapy administration in a facility

04/25/2016

by: Julia Kyles, CPC-A

Question: We have a two-part question about billing for intravenous chemotherapy administration services such as 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump.)

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