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CG Team Blog

Medicare 2016 Update - Quality Tiering for 10+ Eligible Practicioners

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

May 19, 2016 9:00:00 AM

 

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Topics: Medicare 2016 Update

Medicare 2016 Update - What's Your Value Based Payment Score?

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

May 12, 2016 9:00:00 AM

The Value Based Payment Modifier program adjusts a physician's Medicare payment based on quality and cost, taking into account quality and outcome measures. Physicians should utilize the Quality Resource Use Reports (QRURs) as these reports indicate how physician practices will fare under the Value Based Payment Modifier Program. So under this modifier, how can providers calculate their score?

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Topics: Medicare 2016 Update

Medicare 2016 Update - Value Based Payment Modifier

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

May 5, 2016 9:00:00 AM

The Value Based Payment (VBP) Modifier allows differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule based upon the quality of care compared to the cost of care during a performance period. In 2016, the VBP Modifier will include non-physician eligible practitioners (EPs). Take a look at the past and present impacted groups.

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Topics: Medicare 2016 Update

Medicare 2016 Update - Individual & Group Practice Reporting Options

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Apr 28, 2016 9:00:00 AM

2016 individual eligible practitioner (EP) reporting options are dependent upon the measures chosen with several reporting methods to choose from.

Of the measures reported, if the EP sees at least one Medicare patient in a face-to-face encounter, the EP can report at least one measure contained in the cross-cutting measure set.

The Measure-Applicability Validation (MAV) will apply if reporting less than nine measures or less than three domains.

The Group Practice Reporting Option (GPRO) is open to groups with two or more EPs. Reporting options include:

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Topics: Medicare 2016 Update

Medicare 2016 Update - Quality Reporting Programs - PQRS

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Apr 21, 2016 9:00:00 AM

The Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals and group practices to report information on the quality of care to Medicare. PQRS gives participating eligible professionals and group practices the opportunity to assess the quality of care they provide to their patients, ensuring that patients get the right care at the right time.

Let’s take a look at the changes to PQRS quality measures for 2016:

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Topics: Medicare 2016 Update

Medicare 2016 Update - Quality Reporting Programs

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Apr 14, 2016 9:00:00 AM

There are currently three different quality reporting programs: Physician Quality Reporting System (PQRS), Electronic Health Record Incentive Program (EHR Meaningful Use), and Value-Based Modifier (VBM). These programs will end on December 31, 2018, putting the Merit Based Incentive Payment System (MIPS) into place effective January 1, 2019. The MIPS combines the aforementioned PQRS, VBM and EHR Meaningful Use, and will annually measure Medicare Part B providers in four performance categories to derive a "MIPS score,” which can significantly change a provider's Medicare reimbursement in each payment year. The MIPS is based on:

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Topics: Medicare 2016 Update

Medicare 2016 Update - Advance-Care Planning Codes

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Apr 7, 2016 9:00:00 AM

Advance care planning CPT codes are separately payable for Medicare. Codes 99497 and 99498 are used to report the face-to-face service between a physician or other qualified health care professional and a patient, family member, or surrogate in counseling, and discussing advance directives, with or without completing relevant legal forms.

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Topics: Medicare 2016 Update

Medicare 2016 Update - Prolonged Services

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Mar 31, 2016 9:00:00 AM

In the office or other outpatient setting, Medicare will pay for prolonged physician services (CPT code 99354) with direct face-to-face patient contact that requires one hour beyond the usual service, when billed on the same day by the same physician or qualified staff as the companion evaluation and management codes. The time for usual service refers to the typical/average time associated with the companion E&M service as noted in the CPT code. You should report each additional 30 minutes of direct face-to-face patient contact following the first hour of prolonged services with CPT code 99355.

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Topics: Medicare 2016 Update

Medicare 2016 Update - CPT Code Changes

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Mar 24, 2016 9:00:00 AM

The 300 new, deleted, revised, and converted Current Procedural Terminology (CPT) codes for 2016 are here and providers must ensure that they are loaded into billing and EMR system(s). In total, there are 140 new codes, 134 revised codes and 91 codes have been deleted. Here are some of the highlights: 

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Topics: Medicare 2016 Update

Medicare 2016 Update - Major Changes Coming For Surgical Procedures

Posted by Michael S. Lewis, MBA, FACMPE & Deborah Mathis, CPA, CHBC

Mar 17, 2016 9:00:00 AM

Click to edit your new post..Major changes for surgical procedures are still on the horizon. Medicare recently implemented a new rule “eliminating 10- and 90-day global payments for surgical procedures starting in 2017. The change unbundles global surgeon fees for thousands of procedures and requires physicians to bill separately for the day of the surgery (known as a zero-day global payment) and any encounters after that day, rather than bundled claims based on the current global rate. Specifically, the Centers for Medicare and Medicaid Services will eliminate 10-day global surgical payments beginning Jan. 1, 2017, and it will do the same for 90-day payments on Jan. 1, 2018.” ("Daily Briefing." The Advisory Board Company. 13 November 2014.).

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Topics: Medicare 2016 Update