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Online only: CMS dramatically scales back global period data-collection program

11/14/2016

The majority of surgeons who bill Medicare can breathe a sigh of relief: You won’t be required to report mandatory, unpaid G-codes for your post-operative services provided during 10- and 90-day global periods this year.

Online only: Off-campus hospital outpatient services get paid half; physicians’ pay status-quo

11/14/2016

by: Roy Edroso

Physicians who bill under the Medicare physician fee schedule for their work at provider-based hospital departments will see no change under new provisions in the outpatient prospective payment system (OPPS) final rule.

Care management, behavioral health featured in final 2017 fee schedule

11/07/2016

by: DecisionHealth Staff

You’ll find new opportunities to code for services related to care management and behavioral health in 2017, according to the final 2017 Medicare physician fee schedule released Nov. 2. CMS finalized a suite of HCPCS codes for physician-led behavioral health services, two complex chronic care management (CCM) codes, initiating visit codes and more.

Experts: Early MIPS payments will be low – but informed providers do better later

11/07/2016

by: Roy Edroso

Since the Quality Payment Program (QPP) final rule with comment came out Oct. 14, everyone’s been talking about the forgiving MIPS minimums, which allow providers to avoid negative payment adjustments with some simple reporting (PBN 10/24/16). But suppose your practice has been reporting quality measures and wants to rack up many more points to grab the maximum 4% positive adjustment CMS has advertised – what do you do?

Assess plan-of-care changes to bill incident to without fail

11/07/2016

by: Richard Scott

Clear the haze on pesky incident-to rules and avoid your auditors’ crosshairs by summoning up a simple question when your non-physician practitioners (NPPs) bill for work under a physician’s supervision.

Health apps, wearable fitness trackers may trigger HIPAA, need for BAA

11/07/2016

by: Marla Durben Hirsch

As patients increase their use of personal health tools, health care providers need to understand when HIPAA applies to the information patients store on their phones and tablets and around their wrists.

Stay alert for home sleep study payer policies that vary from CPT

11/07/2016

by: Laura Evans, CPC and Julia Kyles, CPC

Question: We have a provider who is billing for home sleep studies with 95800. However, CGS Administrators is denying the service with claims adjustment reason code CO-5 (The procedure code/bill type is inconsistent with the place of service). Can you tell us why we’re getting this denial?

Many chiropractors, NPPs projected to be excluded from MIPS in 2017

11/07/2016

by: Richard Scott

About 41% of the approximately 1.2 million clinicians providing care during the merit-based incentive payment system’s (MIPS) transition year of 2017 will gain an automatic exclusion from the program, but exclusion rates are projected to vary significantly per specialty.

Correction: Updated MIPS exclusion data

11/07/2016

by: Part B News staff

Correction: The benchmark of the week in the Oct. 24, 2016, Part B News contained incorrect percentages of total exclusions from the merit-based incentive payment system (MIPS). The corrected percentages are 51.6% for practices with one to nine clinicians, 50.1% for 10 to 24 physicians, 46.3% for 25 to 99 clinicians and 27.3% for 100 or more clinicians.

Medicare CCM program promising, but has problems

11/01/2016

When CMS debuted its Medicare Chronic Care Management (CCM) Program in 2015, it was expected to be a boon for family practice physicians. The CCM program was designed to help physicians provide more coordinated care for Medicare patients and generate more revenue for practices.

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