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Treating veterans? Check for, return overpayments before the VA asks

07/31/2017

If your practice provides private health care services to veterans through one of the Veterans Health Administration’s initiatives, heads up: The Veterans Administration (VA) has discovered that a computer error caused it to reimburse private providers at the wrong rate, and it will be retrieving overpayments.

Senate Obamacare repeal efforts fail (Updated)

07/31/2017

by: Roy Edroso

In the early morning hours of Friday, July 28, the Senate voted down the last-ditch "skinny" Obamacare repeal bill 51-49, making three unsuccessful Senate attempts to pass repeal-and/or-replace legislation in a week.

Under QPP, virtual groups not expected to get ancillary services exception

07/31/2017

by: Roy Edroso

Question: In the Quality Payment Program (QPP) proposed rule’s virtual groups section, CMS mentions “self-referral” a few times. Why did that come up?

Proposed prolonged status for these codes is great — but do the basics first

07/31/2017

by: Roy Edroso

CMS’ proposal to let 19 preventive services codes be billed with prolonged service add-on codes is good news to many providers. But it’s only good if they can get those codes accepted in the first place — and some of them have given providers trouble.

Physicians want change in prior authorization policies

07/31/2017

The growing demands of administrative work are a major pain point for most physician practices. These tasks include the daily grind of filing prior authorization (PA) requests for basic things like prescriptions and medical procedures, a time-draining process the AMA and other groups are looking to reform.

Focus on medical-decision making, time may newly define E/M services

07/24/2017

by: Richard Scott

You may find significant changes to E/M reporting in the near future, including a pivot away from two key elements — history and physical exam — that largely determine a given level of service for your most common patient encounters.

CMS previews preventive service add-on codes, dozens of new CPT codes

07/24/2017

by: Julia Kyles, CPC

Providers who believe the time spent on preventive services far exceeds the revenue they receive should take note: CMS intends to create add-on codes that will allow providers to report and be reimbursed for some preventive services that last at least 30 minutes longer than the typical time.

Diabetes Prevention Program may start April 1 with laxer recognition rules

07/24/2017

by: Roy Edroso

Most of the proposed changes to a program allowing non-provider “coaches” to bill Medicare for educating pre-diabetics should encourage entrants — especially one making participation in the program quicker and easier. But potential suppliers who hoped to do it all online may be disappointed.

CMS intends to lower the bar for the final year of PQRS participation

07/24/2017

by: Julia Kyles, CPC and Richard Scott

This could be excellent news for clinicians who were facing a pay cut because of their physician quality reporting system (PQRS) performance in 2016: CMS has a two-fold plan to ease the transition from quality reporting to quality payment. The plan involves lower reporting requirements and thresholds for avoiding the value-based modifier payment.

ICD-10 coding not being put to optimal use

07/24/2017

In nearly two years since practices adopted the ICD-10 code set, billing and coding experts say the transition was fairly smooth but that, in most cases, the codes are not being put to their intended use.

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