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ACOs move slowly to full risk-sharing as spending targets come in above mark

04/16/2018

Moving to two-sided risk under CMS’ value-based payment models remains a formidable challenge for provider groups, and new research suggests that no-risk-and-all-bonus payment structures are pushing Medicare spending higher than originally projected.

New CAN-SPAM review increases risk for practices that email their patients

04/16/2018

by: Marla Durben Hirsch

Practices that use email to market services and products to patients should expect more scrutiny. The Federal Trade Commission (FTC) is examining its CAN-SPAM rules that prohibit certain unsolicited email messaging, and the stakes are high for practices.

DOJ task force to target dangerous opioid prescribers, manufacturers

04/16/2018

by: Marla Durben Hirsch

Expect increased scrutiny of your practice’s opioid prescribing habits. The federal government is stepping up its game in the fight against the opioid epidemic, and primary care practices could be on the front lines.

Take 3 steps to ease administrative burden as Medicare rolls out new cards

04/16/2018

by: Roy Edroso

The new Medicare cards, with new beneficiary ID numbers, are rolling out this month. The old numbers don’t become obsolete until January 2020, but preparing now can help your practice avoid a scramble to enter new numbers and help patients avoid scams.

Check the MIPS participation tool, but don’t ignore unexpected results

04/16/2018

by: Julia Kyles

After a delay, the merit-based incentive payment system (MIPS) participation look-up tool is up and running for 2018, but with one big caveat: A clinician could be on the hook for MIPS participation if the tool incorrectly informs her that she doesn’t need to participate.

OK to bill view of asymptomatic knee, but code and document properly

04/16/2018

by: Roy Edroso

Question: A patient presents for an evaluation of unilateral knee pain and we do four standing X-ray views of the knee that capture the contralateral side. We have always billed this scenario as 73564 (Radiologic examination, knee; complete, 4 or more views) with RT or LT as appropriate. There has been some discussion lately that we should bill 73560 (Radiologic examination, knee; 1 or 2 views) for the contralateral views if they are interpreted on. However, I feel if the patient has no complaints on the contralateral side, the medical necessity wouldn't be there even if the X-rays reveal something such as osteoarthritis. Does anyone know of an official source that states whether the contralateral side can be billed or not in the absence of patient complaints?

Check opioid prescribing habits against average for your practice’s specialties

04/16/2018

by: Julia Kyles

Use the latest comparative billing report (CBR) to determine whether your practice’s clinicians may be flagged for a higher-than-average prescribing pattern.

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