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CMS extends its split/shared exception for facility-based visits

11/14/2022

Practices have another year to determine whether a physician or qualified health care professional bills a level-based split/shared visits based on performance of a key component of the encounter — history, physical exam or medical decision-making (MDM).

QPP changes arrive, as later reporting, payment hassles loom

11/14/2022

by: Roy Edroso

Take stock of a series of annual updates to the Quality Payment Program (QPP) and Merit-based Incentive Payment System (MIPS) to succeed in 2023, but watch carefully as CMS prepares for a whole new MIPS paradigm and, for alternative payment model (APM) participants, a possible year without bonuses down the road.

Shared Savings offers rewards for ACOs in underserved areas, but others can benefit

11/14/2022

by: Roy Edroso

By finalizing most of its proposed changes to the Medicare Shared Savings Program (MSSP), CMS is giving massive breaks to new and low-revenue accountable care organizations (ACO) that serve underserved communities, as well as enticements for others to stay. The agency evidently wants to bulk up enrollment, and some experts think it’s worth a try.

Fee schedule round-up: More policy updates coming your way

11/14/2022

by: DecisionHealth Staff

Don’t miss out on additional regulatory changes contained in the final 2023 Medicare physician fee schedule, from global period E/M visits to supply cost revisions and more.

Most specialties projected to lose charges in 2023: Fee schedule

11/14/2022

by: Richard Scott

The number of specialties welcoming a boost to their allowed charges in 2023 is far outpaced by those facing projected cuts, according to relative value unit (RVU) revisions announced in the final 2023 Medicare physician fee schedule released Nov. 1.

MACs team up on national urine drug test policy ‘that will shock some people’

11/07/2022

by: Julia Kyles, CPC

If your practice orders or performs urine drug tests (UDT), take note: Your Medicare administrative contractor (MAC) is working on a new policy for these high-utilization services, and it could go into effect in the next few months.

AMA alerts practices to hidden E/M pay cuts by private payers

11/07/2022

by: Julia Kyles, CPC

Watch your payers’ communications and your remittance advice codes for signs of stealth pay cuts and automatic downcoding, the AMA warns in a 15-page guide the association announced in an email Oct. 21.

CDC loosens up on masks; whether you agree or not, set a clear policy

11/07/2022

by: Roy Edroso

Recent CDC guidance suggests some added flexibility in mask use in medical facilities. If the guidance doesn’t track with your own masking policy, make sure your staff and patients are clear as to where you stand.

New vaccine mandate guidance goes easier, but 100% is still the goal

11/07/2022

by: Roy Edroso

In a revision to its previous guidance on the health worker vaccine mandate, CMS still holds that any less-than-100% compliance is noncompliance but suggests that good-faith efforts may merit a reprieve.

Tips to start the journey to outpatient and ambulatory CDI

11/07/2022

by: Jennifer Boles

Many health care systems are looking at where to expand next in the outpatient and ambulatory medical group settings. Outpatient clinical documentation integrity (CDI) is often focused on hospital emergency department (ED) and observation settings. Ambulatory CDI is viewed as provider-billed charges and focuses on medical group clinics.

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