Look for big changes to ENT procedure coding in 2018

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
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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MIPS survival guide for 2018: How to avoid a negative adjustment

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
MIPS survival guide for 2018: How to avoid a negative adjustment By Grant Huang Director of Content at DoctorsManagement January marks the start of the second year of Medicare’s Merit-based Incentive Payment System (MIPS) – but the end of the transition year. That means tougher minimum reporting requirements just to avoid a negative payment adjust...
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Improve Your E/M Coding by Focusing on Medical Decision Making

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
Improve Your E/M Coding by Focusing on Medical Decision Making By Grant Huang Director of Content at DoctorsManagement Now that CMS is committed to revising its E/M documentation requirements to reduce the burden and complexity they pose to providers, it’s a great time to review the trickiest E/M component: medical decision making (MDM). Remember: CMS...
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ONC Relaxes EHR Certification Rules in a Potentially Risky Move

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
ONC Relaxes EHR Certification Rules in a Potentially Risky Move By Grant Huang Director of Content at DoctorsManagement In a surprise move, the HHS Office of the National Coordinator for Health Information Technology (ONC) is relaxing certification standards for electronic health records (EHR) systems. The announcement came in a Sept. 21 blog post that cited...
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CMS Chief Could Take Over at HHS After Price Resignation

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
CMS Chief Could Take Over at HHS After Price Resignation By Grant Huang Director of Content at DoctorsManagement The sudden resignation of Tom Price, the former Georgia Congressman, from his post as HHS Secretary creates more uncertainty over how the agency will approach crucial initiatives, such as enforcing the politically divisive Affordable Care Act (ACA)...
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Why the Hierarchical Condition Category (HHC) Model Matters

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
Why the Hierarchical Condition Category (HHC) Model Matters By Grant Huang Director of Content at DoctorsManagement For many providers and administrators, Hierarchical Condition Categories (HCCs) are still something of a mystery, a concept that seems to do most of its work in the background. But now, as the healthcare industry accelerates towards alternative payment models,...
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Medicare Therapy Coverage Doesn’t Hinge on Patient ‘Improvement’

By | 2017, Coding and Auditing, Regulatory Compliance
Medicare Therapy Coverage Doesn’t Hinge on Patient ‘Improvement' By Sean M. Weiss Partner, Vice President and Chief Compliance Officer of DoctorsManagement We at DoctorsManagement have been aware of Medicare payers improperly applying the government’s “improvement standard” far too broadly, using it to deny physical and occupational therapy services in particular. This is wrong, and we...
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Supreme Court Ruling Weakens Whistleblower Suits

By | 2017, Coding and Auditing, Regulatory Compliance
Supreme Court Ruling Weakens Whistleblower Suits By Sean M. Weiss Partner, Vice President and Chief Compliance Officer at DoctorsManagement A recent Supreme Court ruling will reduce the success rate of whistleblower lawsuits made against healthcare payers and providers under the False Claims Act (FCA), though it also reaffirms the most consequential aspect of the FCA:...
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