Part B News
New APMs, virtual groups a MACRA rule benefit to few
10/24/2016
by: Roy Edroso
CMS is adding more advanced alternative payment models (APMs) to its list of those that can skip the requirements of the merit-based incentive payment system (MIPS), but the list remains small.
When risk adjusting, don’t skip diagnoses; note exacerbating conditions
10/24/2016
by: Roy Edroso
With almost one in three Medicare beneficiaries now enrolled in a Medicare Advantage plan, according to a Kaiser Family Foundation study, it’s useful for practices just getting started with this kind of reimbursement to understand how it works.
Coder tips from AHIMA: Cross train specialty coders and more
10/24/2016
by: Roy Edroso
A dozen coders traded tips at a physician practice coding roundtable moderated by Crystal Clack, director, HIM practice excellence for AHIMA, during the organization’s annual conference in Baltimore in October. Here are six tips from the trenches.
Watch medical necessity, conduct all tests to avoid lipid-panel denials
10/24/2016
by: Richard Scott

Ensure your documentation adds up and confirm that your provider performed all three of the tests involved in the full lipid panel (80061) to accurately report this highly-used service and avoid letting revenue slip through your fingers.

Low volume biggest reason for practices to qualify for MIPS exclusion
10/24/2016
by: Karen Long
Almost half of practices with one to nine clinicians don’t bill enough or see enough Medicare patients to be subject to the merit-based incentive payment system (MIPS) in 2017.
Small price changes make big differences for most-used drugs in October ASP list
10/17/2016
by: Roy Edroso
A penny-per-dose drop in the price of low osmolar contrast material (LOCM) may not sound like much, but to a radiologist who uses it several times a day, and is reimbursed 106% of average sales price (ASP) by Medicare on it, it will have a big impact over time.
PQRS, value modifier informal review may spare you penalties, but act fast
10/17/2016
by: Roy Edroso

You have until Nov. 30 to defend yourself if you think you’ve been scored on the physician quality reporting system (PQRS) or the value modifier (VM) unfairly – and you should report even suspected errors lest you be wrongly penalized by as much as 6%.

Post notices for patients about grievance policy to meet October compliance date
10/17/2016
by: Marla Durben Hirsch

Don’t fall behind a key compliance date for section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age and disability in any health care program or activity.

Navigate screening vs. diagnostic tests to successfully report prostate screens
10/17/2016
by: Richard Scott

Get a handle on the type of prostate cancer screening you’re providing and shore up your diagnosis coding to rein in runaway denials on this common preventive service.

Q4 drug pricing brings mostly mild changes, with a few big gainers, losers
10/17/2016
by: Roy Edroso
What may be the last quarterly average sales price (ASP) update before a final rule changes the way Medicare reimburses providers for hundreds of drugs is out, with some big changes but a mostly level schedule/
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