Why the Scoring Mechanisms of Medical Decision-Making are Flawed By Shannon DeConda| May 10, 2018 The scoring mechanisms of the MDM are suggested tools, not rules or laws. In our last article we explored how time in conjunction with medical decision-making (MDM) must support the same level of service, and why that rule makes sense....
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CMS eases teaching physician documentation rules Grant Huang, CPC, CPMA Director of Content CMS recently released a transmittal tweaking its requirements for teaching physicians to bill for services that involve medical students (not residents, who have earned their MDs). The move is intended to make it easier for the teaching or attending physician to sign...
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UnitedHealthcare cracks down on level 4, 5 ED codes Providers who submit claims to UnitedHealthcare (UHC) have begun seeing a dramatic change in coding policy, with all facility emergency department (ED) visits coded at level 4 or level 5 undergoing review for adjustment or outright denial. The new policy took effect March 1 and affects...
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Practices fight Blue Cross over growing modifier 25 cuts By Grant Huang Director of Content at Doctors Management It started with one Blue Cross plan in Pennsylvania, but eight other states across the country will start the New Year being subject to the same painful policy: A 50% reduction in reimbursement for all E/M services...
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MedPAC recommends eliminating MIPS By Grant Huang Director of Content at DoctorsManagement A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler version that would not be mandatory like MIPS is for most providers who participate with Medicare. The Medicare Payment...
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MIPS 2018 survival guide: Maximizing your score and bonus By Grant Huang, CPC, CPMA Director of Content at Doctors Management The 2018 performance year for Medicare’s Merit-based Incentive Payment System (MIPS) is well underway and it’s time to look at how you can maximize your providers’ MIPS score for a shot at the exceptional performance...
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Modifier 25 revisited: Bundling E/M visits and procedures By: Scott Kraft, CPC, CPMA Auditor and Consultant at DoctorsManagement As more payers embrace hardline policies to discourage the bundling of E/M services with minor outpatient procedures (see related story, pg. 3), practices must be more disciplined in their use of modifier 25 (significant, separately identifiable evaluation...
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Final GOP tax bill eliminates health insurance mandate A major Republican effort to reform existing tax law is nearing success as this issue of The Business of Medicine goes to press, with the House and Senate reconciling most of their legislative differences. One provision has remained intact in what appears to be the final version...
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Facing provider resistance, Anthem softens modifier 25 policy By Grant Huang Director of Content at DoctorsManagement At least one Blue Cross Blue Shield (BCBS) payer has responded to provider pushback against the modifier 25 payment reduction policy by weakening it. Anthem BCBS has announced that it will change the payment reduction from 50% to 25%...
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Look for big changes to ENT procedure coding in 2018 Endoscopy codes will see some of the biggest changes of all procedure codes next year under Medicare’s 2018 Physician Fee Schedule (PFS) final rule. Below are the highlights. Brand-new endoscopy codes. CMS is introducing five new nasal/sinus endoscopy codes that each represent a bundle of...
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