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PQRS, social trends spur big utilization hikes in some codes

03/30/2015

Code use by Medicare providers fluctuates from year to year, sometimes widely. In fact, 319 codes showed increases of more than 1,000% between 2008 and 2013, the most recent year for which Medicare data is available.

With 2% sequester cut extended, make sure non-Medicare plans don’t try it on you

03/30/2015

by: Roy Edroso

As CMS re-ups the 2% sequestration cut on provider payments, now is a good time to check your private and Medicare Advantage contracts to make sure those payers aren’t taking that cut without cause.

Court: Recovery auditor (RAC) contract payment change violates federal law.

03/30/2015

by: Roy Edroso

Expect the new recovery audit contracts to be delayed further. The U.S. Court of Appeals for the Federal Circuit has ruled that a new provision that would delay paying the auditors their contingency fees until the second level of the appeal process violates federal contracting requirements.

CMS eases burden for voluntary disclosure of one category of Stark law violation.

03/30/2015

by: Roy Edroso

Physicians who violate the Stark law only by not disclosing their ownership or investment interest in a hospital can now voluntarily disclose the violation using new instructions that require less information.

House kicks SGR to the curb, sets new payment path for physicians; Senate vote expected Friday

03/26/2015

by: Part B News staff

Take a deep breath, physicians. If a landmark bill passed in the U.S. House today by a 392-37 vote becomes law, you can say goodbye to the sustainable growth rate (SGR) once and for all.

Avoid a PQRS reporting surprise; check your EHR vendor’s submission capability

03/23/2015

by: Richard Scott

Don’t let a common misconception about Physician Quality Reporting System (PQRS) submission requirements submarine your year-end data reporting, which could leave you on the hook for big penalties in the years to come.

‘Next Generation’ ACO model speeds up P4P transition — and your need to adapt

03/23/2015

by: Roy Edroso

While you may find CMS’ new accountable care organization (ACO) model is too tough for your practice, you should pay attention to this “Next Generation” model anyway because it points to a pay-for-performance future for all Medicare providers.

For injections, ensure decision-making supports billing separate E/M service

03/23/2015

by: Scott Kraft

Be careful when you routinely bill an E/M service along with an injection done during the same encounter. E/M services are typically bundled into most injection codes, and you need to establish separate medical necessity to support billing the E/M service.

More than 150 new codes have daily limits, but they aren’t without appeal

03/23/2015

by: Julia Kyles

Don’t forget to revise your billing system and remind staff to watch for reporting limits on services and supplies, such as fluid drainage and tendon sheath injections, that were added to the medically unlikely file that goes into effect April 1.

CCI update contains new joint injection, myleography edits

03/23/2015

by: Julia Kyles

Don’t ignore the edit update that goes into effect April 1 just because it contains only 1,106 new pairs. The edits may impact the way you report the new joint injection codes, among other changes.

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