Archive | Health Law and Policy RSS feed for this section

Yea or Nay? See Which QPP 2018 Proposals Came Through in the Final Rule

14. December 2017

0 Comments

Back in July, TCI SuperCoder blog had a post about the proposed 2018 Quality Payment Program (QPP) rule, a program established under MACRA. Now that the final rule (with comment period) is out, let’s see how some of those proposals fared. Small Provider Exemption/Low-Volume Threshold Proposal: The proposed rule included adjusting the 2017 low-volume threshold […]

Continue reading...

What Does ICD-10 Have to Do With Prescriptions to Treat Acute Pain?

27. September 2017

0 Comments

We’re just days away from ICD-10 2018 implementation. One group with ICD-10-CM on the brain may be Ohio pharmacists. Here’s why: Effective Dec. 29, 2017, there will be new rules in Ohio for prescribing opioids. One of the requirements is for the prescription to include “The ICD-10-CM medical diagnosis code of the primary disease or […]

Continue reading...

Are These ASCQR Resources on Your List?

5. September 2017

0 Comments

The Ambulatory Surgical Center Quality Reporting (ASCQR) Program affects Medicare reimbursement for ASCs. In short, ASCs have to meet administrative, data collection, and data submission requirements to avoid a payment reduction. Here’s a look at some ASCQR resources recently listed in Outpatient Facility Coding Alert. 1. CMS ASCQR Page The CMS ASCQR page links to […]

Continue reading...

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

25. July 2017

2 Comments

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, […]

Continue reading...

4 Things to Watch From the OPPS 2018 Proposed Rule

21. July 2017

0 Comments

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 […]

Continue reading...

Transition and Flexibility Are the Buzzwords for QPP 2018 Proposed Rule

18. July 2017

0 Comments

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 […]

Continue reading...

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

20. June 2017

0 Comments

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 […]

Continue reading...

MACRA’s Money Effects Depend on Providers, Study Finds

26. May 2017

0 Comments

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. […]

Continue reading...

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

23. May 2017

0 Comments

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 […]

Continue reading...

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

4. April 2017

0 Comments

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 […]

Continue reading...