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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.
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.
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.
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.
Appropriate sharing of records for patients with substance abuse disorders should be easier under a second final rule issued Jan. 3 by HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA). But in some cases, the new rule adds some considerations that might mitigate the advantage.
Physician practices received significant payments — more than $4 billion — on 10 frequently reported E/M services performed the same day as a minor procedure or other service, according to a review of 2016 Medicare claims data, the most recent available.


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