Take the Mystery Out of the MPFS Conversion Factor and Calculations

Mon, Jan 14, 2019

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In the 2019 Medicare Physician Fee Schedule (MPFS), the conversion factor is 36.0391 compared to 35.9996 in 2018. But that sort of information helps only if you know what a conversion factor is and what to do with it. Here’s a primer you can turn to when you need to brush up on your MPFS calculation skills.

Get a Handle on RVUs

The MPFS conversion factor (CF) helps you translate Medicare relative value units (RVUs) into dollar amounts. RVUs represent the relative resources used to provide a service. There are work RVUs, practice expense (PE) RVUs, and malpractice (MP) expense RVUs.

The practice expense RVUs may vary based on the setting of non-facility or …

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Here’s How MIPS Participation Eligibility Shrinks and Grows in 2019

Thu, Jan 10, 2019

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MIPS eligibility 2019

We’re in the third year of the Quality Payment Program (QPP), which includes the Merit-based Incentive Payment System (MIPS). The QPP is connected to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Because MIPS may result in Medicare payment adjustments up or down, knowing whether you’re required to participate is an essential first step. Here’s what the MIPS participation eligibility criteria look like in 2019. (For info on some terminology changes in MIPS 2019, read this blog post.)

See How the List of Eligible Clinician Types Grows

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Modifier 59 Misuse Cost 1 Health System Millions — Know Where to Go for the Rules

Mon, Jan 7, 2019

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False Claims Act settlement modifier 59

Exploiting modifier 59 was a major factor in a recent $12.5 million settlement for False Claims Act allegations. How’s that for motivation to shore up your modifier 59 know-how? Here are some resources to get you on your way.

Read the Write-Up on the Recent False Claims Act Settlement

Find out some of the details that resulted in the $12.5 million settlement and five years of regular monitoring of billing practices for a hospital and health system in Pennsylvania by reading the brief DOJ release about the case. With modifier 59 (Distinct procedural service) in the mix, you can guess that intentional improper unbundling was a …

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HCPCS 2019: Update CROS/BiCROS Hearing Device Codes for a Better Clinical Match

Fri, Jan 4, 2019

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For those of you who report contralateral routing hearing aid devices (CROS/BiCROS), here’s what you need to know about the big makeover these codes got for 2019.

Catch the Little Differences in Code Descriptors

As noted in a previous blog post about HCPCS 2019, the hearing aid codes will test your ability to spot tiny variations in code descriptors. (But as a coder, you are already all about the details, right?)

Pay particular attention to the ends of the descriptors for these new codes. To help …

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Get the Latest on Changes to Medicare’s 2019 History Documentation Requirements

Thu, Dec 20, 2018

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We’ve been talking a lot about the 2019 Medicare Physician Fee Schedule final rule, but when there are changes to E/M rules, there can never be enough information, right? CMS recently released a response to a question that arose during a provider call about what parts of history ancillary staff or the beneficiary can document …

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HCPCS 2019: Get to Know New Code G2012 for Virtual Check-In

Mon, Dec 17, 2018

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Payment for non-face-to-face communication with patients isn’t the most clear-cut topic. But with new 2019 HCPCS code G2012, you’ve got an intriguing option for virtual check-ins with Medicare patients. Ready to learn more?

Dig In to the Long Descriptor for G2012

The first place to learn about the code is the long code descriptor:

  • G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor …
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Obstetrics: Take the Confusion Out of Pre-Existing Hypertension ICD-10-CM Coding

Thu, Dec 13, 2018

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ICD-10 coding for hypertension in pregnancy

Hypertension is a common diagnosis, so a lot of specialties have to understand the rules for coding this condition. Obstetrics coders have to go one step further for hypertension and learn the specific rules for coding pre-existing hypertension in pregnancy, which is our focus today.

Watch for Documentation of Pre-Existing or Gestational

You’ll find the obstetrics codes for hypertensive disorders in the O10-O16 range of ICD-10-CM. Categories O10.- (Pre-existing hypertension complicating pregnancy, childbirth and the puerperium) and O11.- (Pre-existing hypertension with pre-eclampsia) are both specific to pre-existing …

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Pop Quiz: Test Your Assumptions About QPP 2019 Payment Year

Mon, Dec 10, 2018

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QPP pop quiz!

Understanding the Medicare Quality Payment Program (QPP) is tough. But the data Medicare released from the 2017 performance year shows you were up for the challenge. And that’s good news because the 2017 performance year affects 2019 Medicare payments and maybe has helped you prepare for the 2019 performance year, too. Let’s see how you do on a quick quiz about the 2017 QPP performance year.

Ready, Set, Go … to the QPP Questions

Q1: Which number reflects the percentage of MIPS eligible clinicians receiving a positive adjustment AND an adjustment for exceptional performance?

  • A. 2 percent
  • <...

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Do You Land in the Winner Column for MPFS 2019?

Thu, Dec 6, 2018

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For the 2019 Medicare Physician Fee Schedule (MPFS), we’ve talked about E/M and a bit about remote monitoring. But now let’s take a general overview of the ups and downs expected for individual specialties.

Know Where to Find the Info and What It Means

Table 94 of the 2019 MPFS final rule is titled “CY 2019 PFS Estimated Impact on Total Allowed Charges by Specialty.” The table shows allowed charges by specialty; impact of changes to work, practice expense, and malpractice RVUs; and the combined impact of the changes.

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Language Lesson: Add These Terms to Your MIPS 2019 Glossary to Save Research Time

Tue, Dec 4, 2018

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MIPS 2019 GlossaryWhen MACRA and MIPS come up, does it feel like speaking another language? For the 2019 performance year, there are even some new terms to learn. We’ve got the new language and tips on where you’ll see it used so you don’t have to spend time searching.

Collection Type: Apply to Sets of Similar Quality Measures

According to the Quality Payment Program Year 3: Final Rule Overview. the official definition of collection type is, “a set of quality measures with …

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