Why the Scoring Mechanisms of Medical Decision-Making are Flawed

By | 2018, Coding and Auditing, DM in the News, DM Newsflashes
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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MedPAC recommends eliminating MIPS

By | 2018, Coding and Auditing, Practice Operations, Regulatory Compliance
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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Modifier 25 revisited: Bundling E/M visits and procedures

By | 2018, Coding and Auditing, Regulatory Compliance
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

By | 2017, Coding and Auditing, Practice Operations, Regulatory Compliance
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 | 2018, Coding and Auditing, Practice Operations, Regulatory Compliance
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

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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