Blog

Recently Part B Frequently Asked Questions by Novartis – Billing

July 18, 2017

May physicians bill Medicare for off-label uses of chemotherapy drugs? The Centers for Medicare & Medicaid Services (CMS) provides the national guidelines on the unlabeled use for anti-cancer drugs. An off-label usage of a Food and Drug Administration approved drug will be considered for coverage when there are no specific contraindications and one of the …

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Medicare Physician Fee Schedule: CMS Proposes 2018 Payment and Policy Updates

July 14, 2017

On July 13, CMS issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in CY 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship …

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Medicare Musings and Updates

July 13, 2017

Suite of Products & Resources for Billers & Coders Educational Tool — Reminder A revised Medicare Learning Network Suite of Products & Resources for Billers & Coders Educational Tool is available. Learn about: Claims submission Federal initiatives and incentive programs OIG Video: Reporting Fraud to the Office of the Inspector General Do you suspect someone …

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If it is not Signed, then it is not Complete

July 11, 2017

Is your documentation signed and ready for a medical record review? Prior to submitting records to Medicare, you must ensure that the documentation is signed. For medical review purposes, Medicare requires that services provided and/or ordered are authenticated by the author. The signature must be handwritten or electronic. There are several variations of acceptable handwritten and …

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Quality Payment Program Technical Assistance Resource Guide

July 6, 2017

The Centers for Medicare and Medicaid Services (CMS) has recently published the Technical Assistance Resource Guide, which concisely highlights all of the support that is available to clinicians participating in the Quality Payment Program. It contains brief summaries on each branch of technical assistance, contact information, and maps to illustrate coverage areas. You can access …

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FTC Sues To Halt Merger Of ND Physician Groups

June 28, 2017

The Federal Trade Commission has filed a lawsuit in North Dakota federal court to block the merger of two Bismarck-area health care providers, claiming the deal would violate antitrust laws by reducing competition for an array of services in the area.  The FTC, along with the North Dakota attorney general, is seeking to block Sanford …

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CMS is Accepting Future Measures and Activities for Three MIPS Performance Categories until June 30

June 26, 2017

The Centers for Medicare & Medicaid Services’ (CMS) Annual Call for Measures and Activities for the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) is open until June 30, 2017. CMS encourages clinicians, measure stewards, organizations, and other stakeholders to identify and submit measures and activities to be considered for the …

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Modifier 25 Check List

June 23, 2017

Modifier 25 is defined as a significant, separately identifiable Evaluation and Management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service. Often questions are posed regarding whether to bill an E/M visit on the same day as a procedure and/or other services …

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CMS Proposes Quality Payment Program updates to increase flexibility and reduce burdens

June 21, 2017

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability …

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Merit-based Incentive Payment System (MIPS) Updates

June 15, 2017

MIPS Group Reporting: Registration Period Ends June 30 Groups planning to use the CMS Web Interface or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey to submit data for the Merit-based Incentive Payment System (MIPS) must register by June 30. For More Information: Group Registration for CMS Web Interface and …

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