Blog

January 18, 2019

Medicare Preventive Services Educational Tool — Revised A revised Medicare Preventive Services Educational Tool is available. Learn about: HCPCS/CPT and ICD-10 Codes Who is covered Frequency What the beneficiary pays Remittance Advice: An Overview Booklet — Revised A revised Remittance Advice: An Overview Booklet is available. Learn about: Which types are available What information is …

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January 17, 2019

If you work for a healthcare payer and reimburse providers additional money for appending the modifier 22, you should be on the lookout for provider abuse of this modifier. According to the AMA CPT® 2012 manual, modifier 22 is defined as: Increased Procedural Services: When the work required to provide a service is substantially greater …

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January 16, 2019

Elements of Process Improvement 1.Recognize the current state of the practice 2.Define what plans must be in place to improve each state 3.Measure the systems that support the plans 4.Analyze gaps (variance) in system performance benchmarks 5.Improve system elements to achieve benchmarks 6.Control system-level characteristics critical to improvement 7.Standardize the systems that prove to be …

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Haynesboone’s False Claims Act – 2018 Year in Review is out

January 14, 2019

The False Claims Act, 31 U.S.C. §§ 3729 et seq. (FCA), continued to be a significant focus of government and whistleblower activity in 2018. This Year in Review highlights several key developments, including: The recovery by the government of more than $2.8 billion in settlements and judgments in FCA cases in 2018. The aftermath of …

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Year end practice review and comparison to benchmarks

January 9, 2019

As mentioned in my last post, now is the time to conduct a financial review of your practice’s 2018 financial performance. You should compare performance to your 2017 numbers and to industry benchmarks. In the last post, I provided you with a few numbers to look at. Here are some more: Charges by Payor Collections …

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Year end physician practice management review

January 8, 2019

You should be looking at and comparing the following benchmarks to the prior year for the practice and if applicable, by provider, and to the national surveys. Is your practice improving? if not, why not? More benchmarks to follow in future posts but for now we will start with the simple ones: Gross Collection Percentage Net …

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Healthcare entity risk area

January 7, 2019

Business processes such as accounts payable, accounts receivable, payroll, and financial statement close are a standard part of day-to-day operations for healthcare organizations and generally are well-controlled. However, when significant changes occur in the organization or environment – such as leadership changes, regulatory changes, mergers, or acquisitions – or when new technologies supporting these processes …

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Medicare’s Physician Compare Preview Period Extended to January 7

January 3, 2019

The Physician Compare preview period is extended to January 7 at 8 pm ET. Preview your 2017 Quality Payment Program performance information before it will appear on Physician Compare profile pages and in the downloadable database. Access the secured preview through the Quality Payment Program website. For More Information: Physician Compare Preview Period User Guide Medicare Learning …

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New 2019 QPP Resources Available on QPP.CMS.GOV

December 28, 2018

To help you prepare for the 2019 performance year of the Merit-based Incentive Payment System (MIPS), CMS has posted the following new resources to the Quality Payment Program Resource Library. 2019 Medicare Part B Claims Measure Specifications and Supporting Documents – Provides comprehensive descriptions of the 2019 claims measures for the MIPS Quality performance category. …

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Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier

December 21, 2018

Medicare pays Medicare Diabetes Prevention Program (MDPP) suppliers to furnish group-based intervention to at-risk Medicare beneficiaries: Centers for Disease Control and Prevention (CDC)-approved National Diabetes Prevention Program curriculum Up to 2 years of sessions delivered to groups of eligible beneficiaries Find out how to become a Medicare enrolled MDPP supplier: Obtain CDC preliminary or full …

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