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Prepare for new look-up tool, remittance codes to avoid QMB billing infractions

11/06/2017

Take steps to identify patients who have qualified Medicare beneficiary (QMB) status using two new tools – one currently available and one pending – and avoid crossing Medicare’s balance-billing prohibitions that may lead to sanctions.

2018 OPPS final rule: CMS to cut 340B drug program payments by 22.5%

11/06/2017

by: Steven Andrews

Despite opposition from many stakeholders, a bipartisan contingent of Congress and CMS’ own advisory panel, the agency is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released Nov. 1.

Assistant vs. minimum assistant surgeon: Document choice between similar modifiers

11/06/2017

by: Roy Edroso

Question: We’re billing for a second surgeon who did light work on a procedure. What’s the difference between 80 (Assistant surgeon) and 81 (Minimum assistant surgeon)?

NPPs provide bulk of surgical assistance, adding millions in revenue

11/06/2017

by: Richard Scott

Surgeons are most likely to work in tandem with a non-physician practitioner (NPP) when performing a procedure under Medicare Part B, says a review of surgical modifier claims data.

Don’t bill incident-to when NPPs make plan-of-care decisions

10/30/2017

by: Roy Edroso

Question: If a patient is being seen by a non-physician practitioner (NPP) for something like follow-up of sleep apnea and the NPP adjusts the settings of the continuous positive airway pressure (CPAP) device, could the encounter be billed incident to? The provider specifically documented “adjust CPAP setting as needed” in the initial note that established the plan of care.

Physician Compare to offer more scores – and more vulnerabilities for your practice

10/30/2017

by: Roy Edroso

Here’s a reason to care about your providers’ data on Physician Compare, your information for which can be previewed now through Dec. 1: CMS wants to put more of their data there and that will wind up on other, better-attended sites..

Check PQRS, value modifier scores to assess, possibly dispute, 2018 payments

10/30/2017

by: Richard Scott

Don’t forget about the quality-reporting programs of yesteryear just yet; you may face penalties under the physician quality reporting system (PQRS) and value modifier — of up to 4% — in 2018 for your performance during 2016, but you have until Dec. 1 to dispute your results.

Murray-Alexander bill seeks return of CSR payments, but it may already be doomed

10/30/2017

by: Roy Edroso

A Senate bill seeks to restore the cost-sharing reduction (CSR) payments that President Donald Trump stripped from the Affordable Care Act (ACA) — but Trump’s erratic response, not to mention Congressional leadership politics, make its passage extremely difficult. The result: A 20% boost to Obamacare premiums are more likely than not.

Let your PQRS, value modifier scores guide you to early success under MIPS

10/30/2017

by: Richard Scott

Even if you’ve avoided a pay cut under the value modifier program for payment year 2018, don’t disregard your practice-specific quality resource and use report (QRUR). The details inside about your cost performance may steer you to success under the merit-based incentive payment system (MIPS).

Cost-category field testing underway for eligible providers.

10/30/2017

by: Richard Scott

Practices that want to catch a glimpse of how the merit-based incentive payment system’s (MIPS) cost category will work in future years are eligible to participate in a CMS field-testing program

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