CODING FOR THE 2018-2019 INFLUENZA SEASON

2018–2019 Influenza Season – Vaccine Chart   There are many different flu viruses and they are constantly changing. Each year research is done to determine the most common three or four viruses. The composition of U.S. flu vaccines is updated as needed on a yearly basis. For 2018-2019, trivalent (three-component) vaccines are recommended to contain: […]

Highlights of Proposed Changes to MIPS in MPFS Proposed Rule CY 2019

The proposed rule for 2019 was released on July 12, 2018. Meridian Medical Management posted a high overview of proposed changes to Payment Policies under the Medicare Physician Fee Schedule. There are also changes proposed for the Quality Payment Program. Amongst the proposed changes are: Changing the definition of MIPS eligible clinicians to include physical […]

Medicare Physician Fee Schedule Proposed Rule for CY 2019

The proposed rule that will affect some payments under the Medicare Physician Fee Schedule and/or payment methodologies was released by CMS on July 12, 2018. This is a high overview of some of the changes; all clients should review the proposed rule to identify any categories that may affect them. Once the proposed rule is […]

Final 2017 MIPS Scores

2017 Final MIPS Performance Feedback is now available. Special scoring circumstances and all MIPS data submitted or calculated for an individual clinician, group, or APM Entity will be reflected. Final MIPS Performance Feedback includes the 2017 Final Score, 2019 Payment Adjustment Information, and details about measures and activities. Clinicians that participated in either track of […]

Medicare Physician Fee Schedule Database Update – July 2018

July brings changes to the 2018 Medicare Physician Fee Schedule Database (MPFSDB).  Changes are effective for dates of service beginning July 1, 2018. PE RVU Imaging Code Changes CPT Code 71045 (radiologic examination, chest, single view, frontal) and CPT Code 71046 (radiologic examination, chest, two views, frontal and lateral) have changes to the Facility and […]

MIPS Name Change Announced for Advancing Care Information (ACI)

The Centers for Medicare & Medicaid Services (CMS), has announced a name change for the ACI category under the Merit-Based Incentive Payment System (MIPS) to the Promoting Interoperability performance category. Don’t panic! This is not a new performance category, just a name change. CMS feels the name change better reflects their increase focus on interoperability […]

Screening Mammography – Type of Service Code Change

The Type of Service (TOS) code for CPT code 77067 for Screening Mammography will be updated to “1” (Medical Care) instead of “4” (Diagnostic Radiology). This will allow for accurate claim submission and adjudication of screening mammography. Correcting the TOS code for CPT code 77067 allows screening mammography claims to be submitted and adjudicated appropriately […]

Connecticut Supreme Court Allows Patients to Sue Providers for HIPAA Violations

A recent ruling by the Connecticut Supreme Court allows patients, who have suffered losses or harm from the unauthorized disclosure of their protected health information, the right to bring legal action against providers for unauthorized disclosure of their medical records. In this recent Connecticut case, Emily Byrne vs Avery Center for Obstetrics and Gynecology, the […]

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 […]