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CMS reinstates outpatient hospital as eligible POS for exercise therapy program

06/04/2018

Despite short-lived guidance to the contrary, providers who work in a hospital outpatient setting will be eligible to report supervised exercise therapy (SET) services to patients with peripheral artery disease (PAD) when the new Medicare program commences July 2.

Per-capita E/M costs are $465 in Minot, N.D., but nearly $1,600 in Fort Lauderdale

06/04/2018

by: Richard Scott

Your location may determine how much money you earn through routine E/M encounters and, more generally, how patients receive their health care services, according to a Part B News analysis of recently released Medicare claims data.

Prove E/M services are unrelated to surgery to report during global period

05/21/2018

by: Richard Scott

Ensure you can prove that your patient encounters meet modifier 24 guidelines (Unrelated E/M service during a postoperative period) when reporting an E/M service during a patient’s global surgical period or you may be in the crosshairs of your Medicare administrative contractor (MAC).

Physician compensation increasingly includes RVUs – and KPIs – in salary contracts

05/21/2018

by: Roy Edroso

It may seem as if many physicians want their compensation in the reliable form of a straight salary, but a new study from the AMA shows a growing number of physicians relying on other factors as part of their compensation package — which suggests you can add performance expectations in your provider contracts.

Group reporting for MIPS offers advantages for collaborative-minded doctors

05/21/2018

by: Richard Scott

Assess a range of factors, including your practice’s pay scale, specialty mix and type of culture, when considering whether to report as a group under the merit-based incentive payment system (MIPS). And if you’re group-reporting via the CMS Web Interface, don’t forget to register by June 30.

Talk-to-text EHR alternatives get fancier — but watch the basics when you buy

05/21/2018

by: Roy Edroso

If you haven’t adopted a talk-to-text module for your electronic health record (EHR), consider both the virtues and the drawbacks — and recent innovations that may change your providers’ whole relationship to the technology.

Medicare pays for foot orthotics — but under strict conditions

05/21/2018

by: Roy Edroso

Question: We have a podiatrist who is having custom orthotics made for his patients. We have been using L3000 (Foot, insert, removable, molded to patient model, ‘ucb’ type, berkeley shell, each) per his instructions, but Medicare is denying the claims. These orthotics are custom-molded insole inserts. What are we doing wrong?

Foot orthotics hard to bill — unless they meet strict standards

05/21/2018

by: Roy Edroso

The difficulty of getting paid by Medicare for foot orthotics is obvious when you look at the denial rates on related codes. This is obvious from the chart below of codes for foot inserts — including L3000 (Foot, insert, removable, molded to patient model, ‘ucb’ type, berkeley shell, each), with which a reader was having trouble in this issue’s Ask Part B News story (see p. 4).

Direct primary care references in new CMS program plan leave cash-only docs skeptical

05/14/2018

by: Roy Edroso

A CMS program currently in planning stages appears to seek input from the direct primary care (DPC) community — but DPC providers Part B News talked to aren’t sure they see how their model would fit.

ALJ appeals backlog is growing, but several big changes may help providers

05/14/2018

by: Josh Poltilove

Despite HHS’ efforts to reduce the backlog of appeals at the Administrative Law Judge (ALJ) level, the average processing time for appeals has continued to grow. But now, providers caught up in — or contemplating entering — the massive backlog of appeals have several reasons to jump for joy.

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