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Malpractice bill clears House; would cap non-economic damages at $250K

07/17/2017

The House passed a bill June 28 that, if signed into law, would restrict damages on malpractice judgments and even make such suits harder to bring.

Reaching difficult patients requires finding middle ground

07/17/2017

Physicians have been dealing with noncompliant patients for centuries. Even Hippocrates took note of the difficulty of treating patients that didn’t follow his advice, stating that “it is more important to know what sort of person has a disease than what sort of disease a person has.”

Proposed quality payment rule could create snares for EHR quality reporters

07/17/2017

by: Julia Kyles

Under the proposed Quality Payment Program (QPP) rule, providers who report one or more quality measures via electronic health record (EHR) will need to report six measures to receive full credit for the quality category.

Does ‘the patient’s wife insisted’ meet medical necessity?

07/17/2017

by: Roy Edroso

Question: A doctor's note on a patient taking treatment for a shingles outbreak reads, "I did not recommend I&D [incision and drainage], but the patient's wife insisted." Is the provider admitting a lack of medical necessity, rendering the procedure unbillable to insurance (Medicare or other)?

Part B News briefs

07/17/2017

The last MAC to do so requires multi-factor authentication for portal access, and Alaska gains HHS approval for an Affordable Care Act (ACA) waiver.

Denial rates on some vaccine codes stay high; biller education an issue?

07/17/2017

by: Roy Edroso

Denial rates on key vaccine codes from 2013 to 2015, which are the most recent years for Medicare data, have been remarkably consistent and suggest that billing problems with some codes are due to long-known issues. The data also suggest many practices just haven’t caught on yet.

Massive settlement shows OIG will pursue established patient upcoding

07/10/2017

by: Julia Kyles, CPC

Two medical centers in Massachusetts will pay more than $700,000 to settle allegations that they upcoded claims when they failed to follow the rules for new and established patients.

As MIPS ‘one and done’ becomes ‘some and done,’ watch reporting details

07/10/2017

by: Roy Edroso

One and done — the ability to report one measure for the merit-based incentive payment system (MIPS) and avoid the penalty — is over. Now MIPS is “some and done” for providers who want to beat the 2020 payment penalty in the 2018 performance year. Plan carefully to cover the point spread.

Proposed 2018 MIPS scoring: Do the math to be prepared

07/10/2017

by: Roy Edroso

MIPS scoring as described in the 2018 Quality Payment Program (QPP) proposed rule has a lot of moving parts. It helps to focus on the basic math of calculating a score, then factor in the bits and pieces that complicate it.

MIPS complex patient bonus may be coming your way in 2020 payment year

07/10/2017

by: Laura Evans

If your Medicare patients include those with multiple comorbidities, you likely are eligible for a new complex patient bonus CMS is proposing to debut next year.

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