HHS and CMS officials announced on April 22 a new, voluntary demonstration model for primary care providers that would introduce value-based payment as a partial (or in some cases complete) substitute for fee-for-service with varying levels of involvement and risk, to begin as soon as January 2020.

Beware, reporters of modifier 25-appended E/M services: Anthem, one of the nation’s largest payers, has issued a policy update seeking to curtail claims for E/M codes submitted with the oft-used modifier for significant, separately identifiable E/M services.

CMS is letting radiation oncologists bill some E/Ms with superficial radiation therapy (SRT) that had previously been bundled. But those providers should look out: this may be a preliminary step before CMS puts in new regulations that may shake up their reimbursement.

A proposed new national coverage determination (NCD) on ambulatory blood pressure monitoring (ABPM) may open up this service to a whole new subset of your patients – but also requires some investment on your part.

Question: In the “Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household” section of the Medicare Policy Manual, CMS lists several categories of persons whose treatment cannot be billed to Medicare when the related provider treats them. But if a doctor who is not related to me supervises my treatment, but the NPP who actually performs the treatment incident-to is related to me, can the doctor charge for that? Also, if I’m the spouse of one of the doctors in a practice, are all the doctors in that practice prohibited from charging for my treatment?