In CMS
Nov 8th, 2019
HCPCS Level II code changes for 2020 were published by the Centers for Medicare & Medicaid Services (CMS) on Nov. 8. These changes include a comprehensive list of new, revised, and deleted codes used to report Medicare Part B services. 2020 HCPCS Level II will include 191 new codes and modifiers, 62 revised codes, and ...
In Billing
May 23rd, 2019
Beginning July 2019, oncologists who are part of the Center for Medicare & Medicaid Services’ (CMS) voluntary Oncology Care Model (OCM) who haven’t achieved a performance-based payment (PBP) will be switched from a 1-sided risk model to a 2-sided risk model.   According to an Avalere study, half of those being switched will lose money. Avalere advises ...
In Coding
Feb 27th, 2019
Different interpretations of ICD-10-CM coding leave you at risk for improper quality scores and payment. Medical record auditors see a wide range of interpretation among coders and medical organizations regarding when and how overweight, obesity, and morbid obesity diagnosis should be abstracted from records, and regarding body mass index (BMI) reporting. These variances can potentially ...
In Audit
Sep 28th, 2018
The Centers for Medicare & Medicaid (CMS) is releasing the Quality Payment Program (QPP) computer code responsible for calculating quality measures from Medicare claims data submitted by eligible clinicians via Quality Data Codes (QDCs). This code is intended for developers interested in the calculation mechanism supporting QPP Claims to Quality. If QPP is part of your ...
Medical group shows you how to offset fee-for-service revenue loss by effectively using a pay-for-performance model. The journey toward value in healthcare — increasing your organization’s ability to take on risk by elevating quality of care and reducing costs — is not without bumps in the road. Success often depends on how well you navigate ...