Part B News | Part B News

MIPS and APMs offer mutually exclusive reporting, payment tracks

05/16/2016

If you choose to participate as an advanced alternative payment model (APM) under Medicare’s new reimbursement structure, you won’t have to report any measures under the merit-based incentive payment system (MIPS) — even if you want to.

You probably don’t have to take workers’ comp cases — unless they sneak in

05/16/2016

by: Roy Edroso

Question: A patient has come in with a work-related injury that he says he intends to submit to workers’ compensation. Can I refuse to treat him?

Working under multiple TINs could multiply a provider’s PQRS burden

05/16/2016

by: Julia Kyles, CPC-A

Question: A nurse practitioner works for Practice A on Monday and Wednesday. He works for Practice B on Tuesday and Thursday. Practice A wants its providers to participate in the physician quality reporting system (PQRS) via a registry this year, but Practice B still uses claims-based reporting. He feels this is creating extra work. Will he flunk PQRS if he only reports measures for the patients he sees at Practice A?

Special rules for controlled substance samples may not be worth risk, hassle

05/16/2016

by: Scott Kraft

The regulatory and paperwork requirements for dispensing samples of controlled substances out of the office are likely more trouble than they’re worth, especially considering many of these prescriptions won’t cost the patient a lot of money and the lion’s share of office visits occurs while pharmacies are available to quickly fill prescriptions.

Brief: Drug wastage coding requirements tightened

05/16/2016

by: Roy Edroso

A CMS transmittal issued April 29 may change your billing on unused portions of drugs. Starting July 1, all providers must use modifier JW “to identify discarded drugs and biologicals when processing Part B claims."

Denials trend down on post-operative E/M, ophthalmologic codes

05/16/2016

by: Richard Scott

Your post-operative coding likely saw a performance boost in 2014 compared with the previous year, as providers came away with a nearly unanimous decrease in denials related to modifier 24 (Unrelated E/M service by the same physician or other qualified health care professional during a post-operative period) over the two-year period.

Don’t let mixed-method PQRS reporting sink your quality efforts

05/09/2016

by: Julia Kyles, CPC-A

Question: May the doctors and physician assistants at our practice use more than one method to report quality measures – for the physician quality reporting system (PQRS) – to CMS?

CMS proposes fewer measures, combined scoring for inaugural MIPS reporting period

05/09/2016

by: Richard Scott

You could see greater cohesion among Medicare’s quality-reporting programs next year, as well as a single, combined formula tied to positive or negative payment adjustments – but pay attention to notable changes, such as fewer reporting measures and a new group reporting option for electronic health record (EHR) attestation, to get a reporting plan in place and stay in the black on incentive payments.

MIPS proposed rule

05/09/2016

Click on the "download file" link to see the merit-based incentive payment system (MIPS) proposed rule.

Specialists will find specific MIPS measures to report; NPPs now included

05/09/2016

by: Roy Edroso

Some specialists are getting a real break on quality reporting under CMS’ newly proposed quality reporting rule released April 27.

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