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When reporting CCM initiating visit code G0506, watch level of E/M service

03/13/2017

Question: If a patient is brought into the office for the physician or non-physician practitioner (NPP) to develop the chronic care management (CCM) care plan, am I eligible to bill initiating visit code G0506 as well as an E/M office visit code?

Practices vanquish transitional care management demons, boost earnings

03/13/2017

by: Richard Scott

When it comes to billing transitional care management (TCM) codes 99495 and 99496, it appears practice truly does make perfect — or something close. Following some early hiccups, practices netted more than $103 million in reimbursement for TCM claims in 2015, the latest year of available Medicare claims data.

Contractors for small-practice QPP help

03/13/2017

Here are the contractors chosen to help small practices with QPP.

Verma advances; Trump touts tax credits; high-risk pools loom

03/06/2017

by: Richard Scott

On March 2, the Senate Finance Committee cast a narrow 13-12 vote to send Seema Verma, the nominee to lead CMS, ahead to a full Senate confirmation. Best known as the architect of Indiana’s Medicaid program, which is largely centered around block grants as a thoroughfare for coverage, Verma would report to new HHS Secretary Tom Price.

Use benchmark data to predict — and boost — your MIPS quality scores

03/06/2017

by: Richard Scott

Don’t overlook benchmark data when you report quality measures under the merit-based incentive payment system (MIPS) this year. While a 98% success rate for documenting patients’ current medications may sound great, it will leave you more likely to incur a penalty.

Concierge medicine gets more popular – and maybe more possible for you

03/06/2017

by: Roy Edroso

You may not have to give up all insurance for your practice to do concierge medicine, which a recent study shows is becoming more attractive to providers.

Watch billing gaps when you adopt new flu vaccine code 90682

03/06/2017

As the flu season drags on, get ready to add a new line item to your seasonal reporting checklist – but watch out for the slow roll-out of the new vaccine code to avoid any billing hiccups.

When patient comes from ER, watch HPI elements, medication management

03/06/2017

by: Roy Edroso

We saw a patient who was recently in the emergency department (ED). The report states chest pain as the reason for visit/chief complaint. Can we use this as the chief complaint and location as an HPI element if the ED doctor does not restate it?

Low scores can sometimes earn bonuses in MIPS decile scoring scheme

03/06/2017

by: Roy Edroso and Richard Scott

The historical benchmarks that will be used to determine quality measure scores sometimes can be deceiving. These tables, which use only the claims-based reporting benchmarks for process measures, give some idea of how you can find a “sweet spot” for your own reporting.

Exert caution when reporting shared visits for prolonged care services

02/27/2017

by: Richard Scott

Be careful when more than one provider sees a patient for prolonged care because reporting a split/shared visit for codes 99354-99357 comes with a number of precise requirements – such as meeting incident-to rules in the office.

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