Among the proposed new rules is one intended to clarify the contentious “Stark Law” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”). The law prohibits physicians from making referrals for […]
The Centers for Medicare & Medicaid Services (CMS) announced that, beginning in January 2020, CMS will implement shorter and more frequent HCPCS Level II coding cycles for requests to modify the Healthcare Common Procedure Coding System (HCPCS) Level II code set. Under the updated procedures, stakeholders will be able to submit code applications on a quarterly basis […]
HCCs thrive on specificity and ICD-11 will provide a higher level of specificity than in ICD-10. For those of you who are HCC coding for hierarchical condition category (HCC) purposes, you know that HCCs are categories of related ICD-10 codes. Only selected significant conditions to drive a payment HCC coding. That means only conditions that […]
In August, the Centers for Medicare & Medicaid Services (CMS) announced proposed modifications to the Merit-Based Incentive Payment System (MIPS). As physician practices work to understand what’s changed, there are certain aspects of which they need to be aware. The following sections provide key takeaways and offer strategies for meeting the coming year’s requirements. Threshold […]
CMS on Friday issued its 2020 final rules for the Physician Fee Schedule, including a streamlining of evaluation and management services (E/M) reporting that was rolled back from an earlier proposal in a change providers applauded. The final rule, which is mostly unchanged from the proposed rule put forward in July, also cuts payments to physical therapists […]
Hospital and health system executives should monitor these proposals for provisions that will affect their organizations’ operations. The 2020 annual rule cycle has been active for CMS. Several proposals in the outpatient prospective payment system (OPPS) proposed rule is controversial, although there is at least one provider-friendly change. Here’s a roundup of five regulatory rules […]
EDITOR’S NOTE: Five Looking at Ten is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines lessons learned since the nation’s healthcare system adopted ICD-10 transition – many of which are expected to come into play with the looming transition to ICD-11. George Vancore of Blue Cross Blue Shield of Florida appeared as […]
Ensure that your practice’s medical coding for preventive screening mammograms aligns with the most recent guidelines during Breast Cancer Awareness Month in October. Coding Mammograms for Medicare The Centers for Medicare & Medicaid Services (CMS) now acknowledges the CPT® mammogram codes, aligning with industry standards. This streamlines the process for coders to accurately document mammogram […]
Effective revenue cycle management can reduce hospice claim denials, particularly those associated with billing or documentation errors. In addition to slowing down payments or losing revenue, submitting inadequate or incomplete required written documentation is a sure-fire way to bring surveyors or auditors to a hospice’s doorstep. As regulators increasingly fix their eyes on the hospice space, providers […]
Insurers can offer premium discounts or other incentives to engage in healthy activities, but questions remain as to whether wellness programs work. Affordable Care Act plans in 10 states will be able to offer wellness programs, as employer-sponsored plans have been doing for years. The Centers for Medicare and Medicaid Services on Monday announced the opportunity for […]