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Value modifier cuts hit 59% of practices; some results translate to MIPS

02/19/2018

Don’t be surprised if your Medicare rates are a tick or two below expected levels during 2018. Nearly 60% of physician practices are taking up to a 2% hit to payments because of negative adjustments from the value modifier program.

Scripps settles unqualified personnel suit for $1.5 million.

02/19/2018

by: Marla Durben Hirsch

San Diego-based Scripps Health agreed to pay a $1.5 million settlement, the Department of Justice (DOJ) announced Jan. 19.

Just 2% of clinicians will earn lucrative value modifier bonus in 2018

02/19/2018

by: Richard Scott

Most practices will take a cut of 1% to Medicare payments in 2018 or see a neutral adjustment as a result of their performance during the final reporting year of the value modifier program, which CMS phased out at the end of 2016.

Upcoming webinars

02/19/2018

Here are some upcoming and on-demand webinars from DecisionHealth.

10 tips to steer your choice about the BPCI Advanced payment model

02/12/2018

by: Richard Scott

You’ll find a clearer picture of the Bundled Payments for Care Improvement (BPCI) Advanced model after CMS unveiled critical pieces of information about the program during a Jan. 30 open door forum. While one key piece — the program’s target pricing — remains pending, you can assess your fit ahead of the program’s March 12 application deadline.

CMS holds MIPS eligibility information; check your billings to get a clue

02/12/2018

by: Roy Edroso

CMS is late again alerting providers to their eligibility for the merit-based incentive payment system (MIPS), yet the quality reporting period has begun. If you’re on the border of exclusion, run some numbers to see whether it’s worth risking a penalty by assuming you’ll be spared.

Budget bill fixing GPCI floor and therapy cap exception expected to pass

02/12/2018

by: Roy Edroso

The work geographic practice cost indexes (GPCI) floor and therapy cap exception — both of which were allowed to lapse at the end of last year, throwing payments into doubt — are expected to be reinstated by new budget legislation before Congress at press time.

9 ways to avoid the hazards of an OSHA investigation

02/12/2018

by: Marla Durben Hirsch

The change in the White House and lack of an appointed head of the Occupational Safety and Health Administration (OSHA) has apparently not affected the agency’s investigations of health and safety hazards in the workplace, which continue to be robust. OSHA can investigate an alleged violation of its requirements at any time, warns attorney Carla Gunnin with Jackson Lewis in Atlanta. In most instances, the agency will not provide advance notice of an inspection, which entails an opening conference, a walk-through in the employer’s offices and a closing conference.

If the patient leaves the visit early, unless it’s for the ER, it’s no charge

02/12/2018

by: Roy Edroso

Question: We had a patient walk out of an encounter before the doctor could complete her exam. Is there any way to bill for this?

Gastro, ortho specialists report most discontinued, increased procedural services

02/12/2018

by: Richard Scott

When you’re forced to end a procedure early or, alternately, report additional work because of unexpected factors, two little used modifiers – CPT modifiers 53 (Discontinued procedure) and 22 (Increased procedural service) – offer a means to accurately report your efforts.

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