RISE now has three means of reporting through the Merit-Based Incentive Payment System (MIPS): individual, group and the recently added virtual groups. According to the CMS, virtual groups allow individual MIPS-eligible clinicians or groups consisting of not more than 10 MIPS-eligible clinicians to join together and report as if they were a single entity. The…
Search results for: Medicare Part B
The ACR Lobbies Against New Part B Drug Cost Adjustment Rule
The ACR and a number of other physician medical associations are lobbying for an immediate legislative fix to a piece of the MACRA law that factors high-cost Part B drugs into a rheumatology practice’s Medicare reimbursement rate through the Merit-Based Incentive Payment System (MIPS). This change, which goes into effect immediately, will impact practices in…
Trump Administration Proposes Medicare Rules Aimed at Opioids, Drug Costs
(Reuters)—The Trump administration on Thursday proposed changes to Medicare drug plans including limits on opioid prescriptions and rules aimed at reducing drug costs for seniors, such as requiring health insurers to pass on discounts to consumers. To help combat overprescription and abuse of addictive painkillers, the U.S. Centers for Medicare and Medicaid Services (CMS) said…
What You Need to Know about the New Medicare Card Project
Beginning in April 2018, Medicare patients will receive newly designed Medicare identification cards that replace their Social Security numbers (SSNs) with unique, randomly assigned, alphanumeric identification numbers. The Centers for Medicare & Medicaid Services (CMS) is making the change to protect patients 65 and older from exposing their SSNs in efforts to “help prevent fraud,…
Keeping the Pressure on Congress: ACR Opposes Medicare Payment Adjustment Plan, Executive Order
Greetings, advocates! Here’s a brief, interim hodgepodge of updates to keep you posted on government advocacy before the deluge of information swamps you in San Diego. The Next Big Thing: Part B Drug Reimbursements Medicare currently plans to adjust reimbursement of doctors in the MIPS program in 2019, not only based on E/M office services,…
ACR Works to Eliminate Part B Drug Costs from MIPS Payment Adjustments
The ACR is taking steps to clarify a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that, as currently written, would consider the cost of Part B drugs when calculating physician reimbursement under the Merit-Based Incentive Payment System (MIPS). “The ACR is concerned about this, because large cuts to reimbursement for pass-through…
Rheumatology Coding Corner Answer: Prolonged Service without Direct Patient Contact, Part 2
Take the challenge. CPT codes 99358—prolonged evaluation and management (E/M) service before and/or after patient care; first hour 99359—each additional 30 minutes (list separately in addition to codes for prolonged service) Coding Rationale No—This scenario would not support the medical necessity to bill the prolonged service code(s). Keep in mind, the time that the supporting…
CMS Implements Part B Modifiers for Biosimilars
With the advent of biosimilars to the marketplace, the Centers for Medicare and Medicaid Services (CMS) now requires modifiers to identify the manufacturer of a biosimilar/biological product on Part B claims. Modifiers were put in place to provide the CMS with the necessary data needed to track claims payments, as well as the ability to…
Rheumatology Coding Corner Answer: New Patient Prolonged Service Without Direct Patient Contact, Part 1
Take the Challenge. ICD-10 Codes R76.1—Raised antibody titer L20.8—Other atopic dermatitis R20.2—Paresthesia of skin R20.1—Hypoesthesia of skin CPT Codes 99358 and 99359 Rationale The Centers for Medicare & Medicaid Services (CMS) typically does not allow separate payment for physician services that do not require face-to-face time with a patient, but as of Jan. 1, 2017,…
Clinical Thought Process for Proper Medical Decision Making, Part 2
In Part 1 of this series, we covered the vital role of medical decision making in determining the final level to bill for a patient encounter. Medical decision making is the key component in coding because it reflects the intensity of the provider’s cognitive labor. This implies that there’s an unseen component involved in the…
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