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Update Your Knowledge of MIPS Promoting Interoperability for 2019

4. February 2019

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In 2019, there are some changes to the Promoting Interoperability performance category of MIPS. Here’s what you need to know about CEHRT and scoring news for this performance year. Background: MACRA requires the Quality Payment Program (QPP) to include a MIPS performance category on meaningful use of certified EHR technology, the QPP 2019 rule states. […]

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Here’s How Medical Documentation Can Help or Hurt for Reimbursement

24. January 2019

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The 2018 CERT report estimates 58 percent of Medicare improper payments were caused by insufficient documentation (and this is an ongoing trend). More than half is nothing to sneeze at, especially when you consider that those documentation problems could lead to having to repay Medicare or having to spend time working on underpayments. Here’s a […]

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Say Cheese! Medicare Is Paying for Photo and Video Evals in 2019

17. January 2019

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If a picture is worth 1,000 words, how much is evaluating a picture worth? Medicare has taken a stance on that. As of Jan. 1, 2019, Medicare is paying for remote evaluation of pre-recorded patient videos and images reported using G2010. Here’s what we know from the Medicare Physician Fee Schedule Final Rule. Compare Our […]

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

7. January 2019

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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 […]

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

20. December 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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Pop Quiz: Test Your Assumptions About QPP 2019 Payment Year

10. December 2018

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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 […]

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

4. December 2018

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When 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 […]

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Drum Roll: What Does MPFS 2019 Final Rule Say About E/M?

5. November 2018

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Medicare released the CY 2019 Medicare Physician Fee Schedule (MPFS). One of the big questions from the proposed rule was whether E/M payment rules would change. Here are some highlights on what made it into the final rule for E/M and what didn’t. The News You’ve Been Waiting for … The proposal to combine payment […]

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Know 3 Rule-Out Rules for Better ICD-10-CM Coding

25. October 2018

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If you come across documentation that refers to ruling out a diagnosis, it’s time to go on high alert. There are some specific rules you need to follow for ICD-10-CM coding. Here are tips straight from the 2019 ICD-10-CM Official Guidelines for Coding and Reporting (OGs). 1. Know When to Use Codes That Specify ‘Ruled […]

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Smart Move: Know These Top Medicare Denial Reasons AND How to Avoid Them

10. October 2018

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  Let’s put data to work to help prevent denials! CGS is one of the Medicare contractors that provides information on top claim denial reasons, and here we’ll take a look at some denial triggers from August 2018 and how you can prevent them. Check Status Before Reporting Duplicate Service Reporting the exact same service […]

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