Part B News
Foot-dragging on Stark reform leaves APMs at risk, slows growth of program
04/02/2018
by: Roy Edroso

Congressional foot-dragging on reform of Stark and other fraud-and-abuse laws may leave providers in alternative payment models (APMs) subject to penalties even if they’re acting in good faith — which may be making the program too difficult for all but the richest entrants to attempt.

Understand payer tendencies, create a path of least resistance for prior authorizations
04/02/2018
by: Richard Scott

Tame the process for gaining prior authorizations to limit the amount of administrative burden you face and you may free up significant staff time and even improve patient care.

Prepare to defend inpatient TKA in face of payer, hospital pressure
04/02/2018
by: Laura Evans

Orthopedic practices: Don’t be caught off-guard if hospitals compel you to schedule total knee replacements in the outpatient hospital setting this year. Medicare removed total knee arthroplasty (TKA) code 27447 from the inpatient-only list, opening the door for providers to perform the procedures in the outpatient setting.

AMA docs: Prior authorizations can be lengthy, often impact care
04/02/2018
by: Roy Edroso

An AMA survey of 1,000 practicing physicians finds that prior authorization for medical services isn’t just annoying for them — it’s possibly a net loss for their patients’ health.

Add practice revenue, get a leg up on MIPS by wrapping in CCM services
03/26/2018
by: Richard Scott
Enrolling patients in a chronic care management (CCM) program can cut back on total health spending while adding revenue to your practice, resulting in a win for your bottom line that also positions you to perform well under quality-reporting and value-based programs.
Private equity deals can mean quick cash now and later – for the right kind of practice
03/26/2018
by: Roy Edroso

If want to get a private equity deal for your practice, you’ll have to demonstrate high future revenue potential and do a lot of due diligence before you even get to the table. But that work could mean a big payday for the physicians and their partners who own the practice.

3 last-minute tips to avoid a MIPS penalty for the 2017 reporting year
03/26/2018
by: Richard Scott
The reporting deadline for the inaugural merit-based incentive payment system (MIPS) year is coming up fast — it’s March 31 for nearly all reporting methods, including claims and electronic health record (EHR) reporting — but that may leave enough time for a final shot.
Some payers accept consult codes — but be sure that’s what you did
03/26/2018
by: Roy Edroso
Question: For new patients who are not on Medicare, our office uses the office consultation codes 99241-99245 if referred by a doctor and 99201-99205 if self-referred. The E/M criteria are met for time, history and exam for all codes. Is our use of the consultation codes correct? Is it commercial carrier dependent?
Some providers continue to bill Medicare for non-covered consultation codes
03/26/2018
by: Richard Scott
Despite Medicare’s decision to no longer cover a suite of five outpatient consultation codes (99241-99245) nearly a decade ago, providers continue to pursue a mission impossible and seek payment for thousands of visits per year.
Document thoroughly, wrap in specific history and exam when prescribing CPAPs
03/19/2018
by: Richard Scott
Don’t overlook Medicare’s stringent documentation requirements when referring patients for continuous positive airway pressure (CPAP) devices or you may get caught up in denied claims that leave your patients without coverage.
Prev Next

Login

User Name:
Password:
Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.
Quick Links
Learning Opportunities
See more...
Forum

The Forum is temporarily unavailable.

click icon to expand
Back to top
Privacy Policy
|
Terms of Use
|
© 2025 DecisionHealth, an HCPro Brand