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Ups and Downs, MACRA Modifiers, and E/M DGs in MPFS 2018 Proposed Rule

25. July 2017

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Part 3 of our proposed rule extravaganza is about the Medicare Physician Fee Schedule (MPFS) 2018 proposed rule. (Part 1 was QPP and Part 2 was OPPS). Let’s get down to business, checking out some highlights explained in recent issues of Medicare Compliance and Reimbursement. Plusses and Minuses The proposed 2018 conversion factor is 35.99, […]

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4 Things to Watch From the OPPS 2018 Proposed Rule

21. July 2017

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We’re back for another installment of “what does 2018 (maybe) have in store”? We just covered the QPP proposed rule, and now we’ll take a look at the 2018 hospital outpatient prospective payment system (OPPS) proposed rule. CMS expects an overall 2 percent payment increase in 2018 (except for the changes mentioned in question 3 […]

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Transition and Flexibility Are the Buzzwords for QPP 2018 Proposed Rule

18. July 2017

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CMS released the proposed 2018 Quality Payment Program (QPP) rule on June 20. To sum up the 1,000+ pages, 2018 will be something of a transition year like 2017 was for QPP, which was established under MACRA. If you read through the various summaries available, you’ll see the term “flexibility” used quite often, with specialty […]

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Don’t Get Too Comfortable With That Meaningful Use Payment – Here’s Why

20. June 2017

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When the title of an OIG report is about Medicare paying out hundreds of millions it shouldn’t have, that’s not great news for Medicare or the providers who got those funds. But that’s exactly what a report released June 12, 2017, says: “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did […]

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MACRA’s Money Effects Depend on Providers, Study Finds

26. May 2017

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MACRA and its shift to a value-based payment model has people in the business of healthcare talking. While most of us may be thinking about the MIPS (Merit-Based Incentive Payment System) track for the Quality Payment Program, there is another option: Alternative Payment Models (APMs). An APM offers incentive payments for high quality, cost-efficient care. […]

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Here’s What’s in Store for Medicare Advantage and Part D in 2018

23. May 2017

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Check out these bullet points for highlights from the 2018 Medicare Advantage and Part D payment and policy updates posted by CMS. Medicare Advantage Medicare Advantage (MA) plans, sometimes called Medicare Part C, are private plans approved by Medicare for people enrolled in Medicare. Medicare pays a fixed amount to the MA plan company, and […]

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60 Days & 6 Years: The Numbers to Know to Comply With Medicare’s Overpayment Rule

4. April 2017

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You get a fairly clear picture of what this rule is about from its name: Medicare Reporting and Returning of Self-Identified Overpayments. If you discover Medicare gave you too much money, you have to give it back. But there are some layers here, so let’s dig in for a refresher on some of the more […]

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How Do AHCA Amendments Affect Medicaid?

23. March 2017

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The US House of Representatives is scheduled to vote on the American Health Care Act (AHCA) today, Thursday, March 23, 2017. To put it mildly, there are more than a few opinions out there about AHCA. The GOP bill repeals and replaces the Affordable Care Act, often called the ACA or Obamacare. If the bill […]

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Get a Glimpse at Potential 2018 MACRA Coding Requirement for Patient Relationship Category

3. March 2017

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There could be new HCPCS modifiers coming your way as part of MACRA to identify patient relationship categories. If the term “patient relationship categories” is new to you, then here’s a brief overview. MACRA requires patient relationship categories and codes as part of an effort to improve resource attribution to clinicians. So there’s a look […]

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Translate HIMSS17 Tips Into Career Advice for 2017

24. February 2017

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This past week, two of our newsletter editors from The Coding Institute attended health IT conference HIMSS17 and Tweeted highlights from sessions. One point that came through loud and clear is that no matter what job you have in healthcare, data connections are so intertwined you have to expand your thinking beyond your own department. […]

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