Tag Archive | "Medicare"

Do You Know About Medicare Add-On Code Edits? You Should!

Monday, February 11, 2019

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Pairing an add-on code with an appropriate primary code is a key factor in bringing in that extra add-on reimbursement. The CPT® manual often provides a listing of appropriate primary codes for an add-on code, but not always. In those cases, you may find answers in Medicare’s Add-On Code Edits, our topic for today. Know […]

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Primary Care and Specialists Need to Know These Twin Add-On Codes by 2021

Monday, January 28, 2019

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The 2019 MPFS proposed rule discussed potential add-on G codes to represent E/M visit complexity. Here’s a quick look at the intent of the proposed codes and what the final rule had to say about their implementation in 2021. See What Happens to This Code for Specialists In the 2019 Medicare Physician Fee Schedule (MPFS) […]

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

Thursday, January 24, 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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Outpatient Coders: Are These C Codes on Your Procedure Reporting List?

Tuesday, January 22, 2019

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The HCPCS 2019 code set features several new C codes related to reporting procedures. If you use C codes, make sure you’ve got these updates on your radar. Reminder: HCPCS C codes are intended for use by Outpatient Prospective Payment System (OPPS) hospitals. The codes are used to report device categories, new technology procedures, and […]

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

Thursday, January 17, 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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Take the Mystery Out of the MPFS Conversion Factor and Calculations

Monday, January 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 […]

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

Thursday, January 10, 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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HCPCS 2019: Get to Know New Code G2012 for Virtual Check-In

Monday, December 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 […]

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Pop Quiz: Test Your Assumptions About QPP 2019 Payment Year

Monday, December 10, 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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Drum Roll: What Does MPFS 2019 Final Rule Say About E/M?

Monday, November 5, 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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