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New bundled payment model gives providers entry to advanced APMs

01/22/2018

You’ll find a new entry into the world of advanced alternative payment models (APM) after CMS announced the Bundled Payments for Care Improvement (BPCI) Advanced program, which will reward providers on the basis of their cost-containment and quality scores for 32 distinct episodes of care.

Denials down on all top codes – and not bad with many others – with modifier 24 in 2016

01/22/2018

by: Roy Edroso

The good news for practices whose providers tend to use modifier 24 (Unrelated E/M, same physician, post-operative) is that the denial rates of the codes most often used with that modifier went down in 2016, the most recent year of available Medicare data.

Modifier 25 payment cuts delayed until March; opposition continues

01/15/2018

by: Richard Scott

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.

QPP reporting portal open; report and get preliminary scores – but hurry

01/15/2018

by: Roy Edroso

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.

Thousands of providers get GPCI cuts caused by MACRA expiration; payback uncertain

01/15/2018

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.

At hearing, Azar open to mandatory bundled programs, drug price deals

01/15/2018

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.

New SAMHSA rule reduces required consent for substance abuse records

01/15/2018

by: Roy Edroso

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.

Specialists spread the love on modifier 25-appended E/M claims

01/15/2018

by: Richard Scott

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.

Congress unlikely to cut Medicare, patients’ coverage this year -- but states may act

01/08/2018

by: Roy Edroso

Despite high-level talk of cuts to Medicare and Medicaid and a recent blow to the Affordable Care Act (ACA), you don’t need to worry too much about further cuts to federal programs in 2018. But do watch for state-level changes that could impact the way your patients’ coverage works.

Keep track of time to seize payment for new add-on codes to preventive services

01/08/2018

by: Richard Scott

With the introduction of two new codes in 2018, you’ll find a pathway to reporting the extra time your physician or clinical staff spends with patients during an encounter involving Medicare-covered preventive services, such as an annual wellness visit (AWV) or lung cancer screening.

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