Protecting Access to Medicare Act (PAMA) Keeping Informed: Appropriate Use Criteria (AUC)

PAMA established a new program to raise the number of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. This program requires the ordering professional to consult a qualified Clinical Decision Support Mechanism (CDSM) at the time advanced imaging services are ordered for a Medicare beneficiary. CDSMs are the electronic portals where ordering professionals can […]

Introduction to Patient Relationship Categories and Codes

Introduction to Patient Relationship Categories and Codes In 2017 MACRA revoked the Sustainable Growth Rate (SGR) formula and introduced the Quality Payment Program; a payment program based on quality of care and not quantity. The Quality Payment Program assesses clinicians on a range of performance categories including the cost category. MACRA requires the development of […]

Receive Full Credit for 2018 MIPS IA Category by Participating in CMS Study

Apply by April 30, 2018 CMS is studying burdens on clinicians associated with reporting Quality Measures under the Merit-Based Incentive Payment System (MIPS) and would like input from MIPS eligible clinicians. Clinicians who successfully participate in the study will be given full credit for the 2018 MIPS Improvement Activity (IA) category. Applications for the study […]

2017 MIPS Reporting Deadlines Are Fast Approaching, Are You Ready?

You can still avoid a 4% negative fee adjustment in payment year 2019 by submitting data for reporting year 2017 but you do not have a lot of time left to report! If you are planning on reporting for 2017 MIPS, here are some critical dates that are quickly approaching: March 1, 2018 – was […]

Payment Reduction for X-Rays Taken Using Computed Radiography

Effective January 1, 2018, payments for imaging services that are X-rays taken using computed radiography (including the technical component portion of a global service) provided during CY 2018, 2019, 2020, 2021, or 2022, will be decreased by 7 percent. For CY 2023 and subsequent years, payments will be decreased by 10 percent for these services. […]

MIPS – Changes for 2018

Just when you think you have a proficient grasp on the new CMS Quality Payment Program-The Merit-based Incentive Payment System (MIPS) has changes in store for January 1, 2018.  There are some helpful changes such as an increase to the “Low-Volume threshold” and additional points being awarded for improvement in the Quality and cost category […]

CPT 2018 Summary of Changes

CPT changes go into effect on 1/1/2018. A few highlights for frequently used categories are noted below. Please refer to the spreadsheet link here to review all code additions, deletions and revisions. The spreadsheet includes a summary tab and additional tabs separated by specialty. For ease of review, the code change category is noted in […]

News From the National Oncology PET Registry

Closure of NOPR (NaF-PET) on December 14, 2017  On December 15, 2015, The Centers for Medicare & Medicaid Services (CMS) issued a final decision memorandum http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=279 pertaining to the coverage of bone PET with F-18 sodium fluoride (NaF-PET) to identify bone metastasis. This National Coverage Decision (NCD) extended the requirement for coverage with evidence development (CED) under […]

Highlights of the CY 2018 Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) published the CY 2018 PFS proposed rule on July 21, 2017. This proposed rule includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare PFS on or after January 1, 2018. Under the PFS, payments include services provided by physicians […]

OVERVIEW OF ICD-10 CODE: ADDITIONS, REVISIONS, AND DELETIONS – EFFECTIVE 10-1-2017

CMS has made available the updated ICD-10-CM and ICD-10-PCS Code lists for 2018. These codes take effect on October 1, 2017. This summary identifies the new codes added, any revised codes, and the deleted codes. The link following this summary document will provide you with the new, revised, or deleted codes by specialty. Reminder: ICD-10 […]