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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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 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 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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