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Make sure the MVP fits your clinicians, run traditional MIPS as a backup

08/14/2023

Participation in the Merit-Based Incentive Payment System Value Pathway (MVP) program gives providers another opportunity to meet their quality payment participation goals this year.

On MA prior auth, Congress proposes relief — but CMS is ahead of the game

08/14/2023

by: Roy Edroso

A couple of new bills — or rather, retreads of old bills — demonstrate increased congressional interest in reforming prior authorization (PA) under Medicare Advantage (MA). While the success of these bills is not assured, a recent proposed rule shows CMS is willing to move on this issue itself, with Congress serving more as a cheerleader than as a legal authority.

CMMI dementia model aims to aid unpaid caregivers, patients

08/14/2023

by: Roy Edroso

CMS is launching a demonstration model that is not only aimed at dementia patients, a growing segment of U.S. health care consumers, but also designed to help these patients’ unpaid at-home caregivers via care coordination and "respite services."

More coverage of the proposed PFS: Vaccine pricing, policy updates and more

08/14/2023

by: Roy Edroso

Don’t miss out on yet more policy changes contained in the proposed 2024 Medicare physician fee schedule, from vaccine payments to the never-used Appropriate Use criteria and more. Get all the latest here:

E/M fee preview: Care management service tops list with 26% pay jump

08/14/2023

by: Richard Scott and Laura Evans, CPC

A number of services in the E/M category are on track for big pay gains in CY 2024, led by behavioral health care management (99484), set for a 26% jump to $54 per service, and joined by two prolonged services codes (99415, 99416).

First payable code shows virtual reality’s advance, as other pay models await

08/07/2023

by: Roy Edroso

There’s a lot of talk about virtual reality (VR) in health care, despite the lack of direct reimbursement for its use from payers. Experts say there are current opportunities for VR as an added benefit in some health care settings, and plenty of developmental activity that’s promising for the future. But for most providers, both the patient benefits and the payments may be years away.

Cultivate Medicare prolonged service rule compliance with a decision tree

08/07/2023

by: Julia Kyles, CPC

Use this decision tree to illustrate Medicare’s rules for coding prolonged E/M services. Medicare created codes and rules for prolonged services performed by a physician or qualified health care professional (QHP) because it disagrees with portions of the CPT guidelines.

To boost diabetes program, CMS revamps code set, extends virtual options

08/07/2023

by: Richard Scott

Due to billing confusion, low utilization rates and patient retention challenges, CMS seeks to deliver a sleeker design behind the Medicare Diabetes Prevention Program (MDPP) in 2024. The agency plans to chop the number of HCPCS codes eligible for reporting while maintaining virtual options for patient encounters, according to the proposed 2024 Medicare physician fee schedule released July 13.

CMS to kick 19 therapy codes back to the RUC for review

08/07/2023

by: Laura Evans, CPC

In a potential windfall for therapy practices, CMS stated in the proposed 2024 Medicare physician fee schedule, released July 13, that it would consider revaluing 19 therapy codes to evaluate whether they had been misvalued during their last review five years ago.

Determine key tips for reporting SDOH in ICD-10-CM

08/07/2023

by: Savannah Schmidt

Question: What are some tips for organizations that are just starting out capturing the type of information to report social determinant of health (SDOH) diagnoses in ICD-10-CM?

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