At the end of July, Medicare released a set of modifiers that you need to know if you’re involved in ordering or coding for imaging. The modifiers, effective Jan. 1, 2020, are part of Medicare’s changes related to Appropriate Use Criteria (AUC) for advanced diagnostic imaging services. Check out the AUC-related modifiers below and then […]
Continue reading...5. August 2019
Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to revise E/M coding in 2021. But what does the MPFS say about Medicare payment for office/outpatient visits in 2021? Here’s the scoop. Know What to […]
Continue reading...2. May 2019
Determining date of service (DOS) can be harder than it seems. Once you dive into the world of professional/technical components, monitoring services, and other non-obvious DOS possibilities, things get complicated fast. You can use the Medicare rules below as a starting point. Apply Different Dates for Radiology Components For many radiology codes, the Medicare Physician […]
Continue reading...8. April 2019
Audit discussions often focus on the fear of upcoding and having to hope that repaying the extra amount is the worst of the consequences. But downcoding is another problem area affecting your payments and more. Here’s why you should never purposely downcode your services. Start With a CERT Story Wondering about the $325 million in […]
Continue reading...18. March 2019
Ready for some retroactive MPFS changes? The next Medicare Physician Fee Schedule update may have an April 1, 2019, implementation date, but the effective date is Jan. 1, 2019. The theme for the HCPCS codes involved is Next Generation Accountable Care Organization (NGACO) Model Post Discharge Home Visits. Remember: “MACs will not search their files […]
Continue reading...12. March 2019
OIG audit targets can feel like moving targets with the website updated each month. Find out where you can go to keep tabs on the Office of Inspector General’s Work Plan items, and see an example of a recently added area to watch. (Tip: For more OIG information, you also can check out this free […]
Continue reading...4. February 2019
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. […]
Continue reading...24. January 2019
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 […]
Continue reading...17. January 2019
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 […]
Continue reading...14. January 2019
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 […]
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12. August 2019
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