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Take the Mystery Out of the MPFS Conversion Factor and Calculations

14. January 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 […]

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

10. January 2019

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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 […]

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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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3 Easy Steps to Finding the Right E/M Level Using an E/M Calculator

15. November 2018

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Have you checked out our free, new E/M Calculator yet? Using it is straightforward, but having a guide can be handy when a tool is new. Here’s how it works. 1. Access the E/M Calculator If you’re going to use a tool, the first step is to get to it! If you aren’t a subscriber […]

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3 Tips to Keep Patient-Payment Collection Humming Along

13. November 2018

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Filing third-party claims is a big part of the business of medicine, but collecting payment from patients is also crucial to a healthy organization. There are challenges, though. Check out these tips on steering clear of problems and on handling those issues that do come up. 1. Have a Policy and Let Patients Know You […]

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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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Ask Yourself These Questions When Working Appeals

29. October 2018

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Sometimes it’s the simple things that can help your appeal for a medical insurance claim. Work through these questions to be sure you’re giving a claim its best chance. Did You Cite the Claim? You may get your appeal back if you don’t make it clear which original claim you’re referencing. Plenty of coders and […]

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