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Will Trump end the ACA? Some practices approve; experts say not so fast

11/21/2016

Practices are optimistic that President-elect Donald Trump’s promised quick repeal of Obamacare will improve their fortunes and their patients’ options, according to 85 respondents of a recent Part B News survey. But experts warn that the changes, whatever they may be, will probably come slower than expected.

Navigate historical vs. current diagnoses to gain the risk-adjustment upper hand

11/21/2016

by: Richard Scott

Be on the lookout for common problem areas in your risk-adjustment coding, such as “history of” diagnoses, to ensure you’re achieving correct risk scores — and fair payment.

CMS attributes patients to specialties based on E/M volume, NPPs’ work

11/21/2016

by: Julia Kyles, CPC

Specialists who are facing a value-based modifier cut because they were ranked as high cost in 2015 should take a close look at how patients were attributed to them and act now to avoid a repeat cut based on their 2016 performance.

Don’t skimp on the details you send with an informal review request

11/21/2016

by: Julia Kyles, CPC

A practice may dispute CMS’ determination that it should receive a quality pay cut in 2017, but it will need to submit at least one informal review request to CMS by Nov. 30 (see story). The review is a practice’s only chance to contest CMS’ findings.

10 tips to implement antidiscrimination grievance policy outlined in section 1557

11/21/2016

by: Marla Durben Hirsch

Be ready to comply with section 1557 of the Affordable Care Act, which prohibits discrimination, by following 10 key steps.

Determine whether you meet the low threshold for MIPS exclusion with 3 FAQs

11/21/2016

by: Julia Kyles

As part of its pick-your-pace approach to the merit-based incentive payment system (MIPS), CMS will excuse some practices from reporting in 2017. The following FAQ, based on subscriber questions, provides guidance on who meets the low-threshold requirements.

Part B News survey: Practices divided on effects of possible ACA repeal

11/21/2016

by: Richard Scott

In the run-up to what may be a year of seismic shifts in the health insurance market following a divisive election season, medical practices are projecting a potential mixed bag of outcomes should the Patient Protection and Affordable Care Act (ACA) come asunder.

Capture additional dollars with new, reworked CCM codes as CMS eases rules

11/14/2016

by: Richard Scott

Take a good look at the changing chronic care management (CCM) landscape for 2017 to capitalize on new and revised services, which include a 5% pay boost for 99490 and the introduction of three CCM-related codes.

Shared Savings ACOs get assigned beneficiaries, measure changes in fee schedule

11/14/2016

by: Roy Edroso

CMS will begin allowing prospective assignment of beneficiaries to Shared Savings accountable care organizations (ACOs), meaning practices will know which patients are assigned to them before providing care – but that probably won’t help control their quality scoring.

Medicare’s moderate sedation policy puts a wrinkle in time — and your coding

11/14/2016

by: Julia Kyles

Make sure staff — and your billing software — pick up on three new twists to moderate sedation billing when the surgeon who performs certain gastrointestinal procedures also provides the moderate sedation for patients over the age of 4.

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