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Practices gain $16 million for advance care planning over 6-month period

02/27/2017

Some states took home outsize portions of the total revenue tied to two advance care planning codes — 99497 and 99498 — over the first six months of 2016.

Training opportunities from DecisionHealth

02/27/2017

Check out these training opportunities from DecisionHealth.

Medicare Spending and Utilization Data for Advanced Care Planning (ACP) Services by State, Jan 1, 2016 through June 30, 2016

02/27/2017

Medicare Spending and Utilization Data for Advanced Care Planning (ACP) Services by State, Jan 1, 2016 through June 30, 2016.

MIPS revised rules retain some old problems

02/21/2017

The start of 2017 marked the beginning of a transitional period for the Merit-Based Incentive Payment System (MIPS). And for the most part, physicians and analysts consider the changes approved last year by CMS to be a solid start to reducing the complexity and burdensome requirements that have plagued quality reporting and meaningful use programs.

Interoperability of EHRs still an issue for CHIME

02/21/2017

Healthcare information technology (IT) associations have endorsed some aspects of the federal government’s revisions to the Merit-Based Incentive Payment System (MIPS) and the Medicare Access and CHIP Reauthorization Act, but one group says the changes don’t address a major barrier preventing providers from sharing information with one another.

Price confirmed, Verma up next; proposed rule seeks to stabilize ACA markets

02/20/2017

by: Richard Scott

After several contentious hearings on Capitol Hill and a rule change in the Senate Finance Committee to allow his nomination to move forward, Price became the 23rd secretary of HHS when Congress confirmed him Feb. 10.

Quality, attestation, risk adjustment create compliance traps for doctors

02/20/2017

by: Marla Durben Hirsch

It’s not just improper billing that can lead to legal hot water. Providers need to make sure that their quality reporting is correct. If not, they face more than a pay cut for failing follow to a quality program’s requirements; the government can also accuse you of violating the False Claims Act.

Use X modifiers to decrease denials, even if CMS has offered scant instructions

02/20/2017

by: Roy Edroso

If you’re taking Medicare’s silence on X modifiers as a sign that you don’t need to think about them, reconsider; they’re already lowering denial rates.

Check trends, claims data to avoid undercoding E/M office visits

02/20/2017

by: Richard Scott

You may be falsely reporting your E/M claims if you don’t code to the highest level of service that your encounters demand. Practices left significant dollars on the table in 2016 because of undercoding, or reporting at a lower level of service than warranted.

Retired spouse’s insurance should be secondary to Medicare — but check

02/20/2017

by: Roy Edroso

Question: I have a patient who is on Medicare but was until recently also covered under his wife’s group health plan at work, which made Medicare his secondary payer. He tells me his wife recently retired. She has kept up the insurance for both of them, but our understanding (and the patient’s) is that in this case, the group plan should now be the secondary and Medicare the primary. Medicare doesn’t acknowledge it, though. What to do?

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