Medicare

Medicare Fee Schedule Cut, Quality Requirements Unsustainable Amid Pandemic, TMA Tells CMS - 09/24/2021

While applauding a Medicare proposal to continue offering telehealth flexibilities, the Texas Medical Association objected to several other proposed pieces of the 2022 Medicare physician fee schedule,  foremost a pay cut for many physicians serving that patient population especially during a pandemic.


Code Carefully for Bilateral Procedures - 09/22/2021

Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.


Texas ACOs Produce Millions in Medicare Shared Savings Despite Pandemic - 09/09/2021

After a transition year in 2019,  accountable care organizations (ACOs) enrolled in the Medicare Shared Savings Program (MSSP) faced another daunting challenge: the COVID-19 pandemic.


Practice e-Tips on Medicare - 09/01/2021

Get practice tips on all things Medicare. Learn what Medicare requires for enrollment, participation, billing, claims, coding, documentation, and more.


ESRD Calculator - 08/27/2021

ESRD Calculator


Notice to Patients of Noncovered Services - 08/27/2021

Notice to Patients of Noncovered Services


How Do I Get Started With CCM Services? - 08/19/2021

CCM services are non-face-to-face activities performed by you or your clinical staff to manage and coordinate the care of your patients. To initiate the services, Medicare requires that you first obtain a patient’s informed and written consent* during a face-to-face visit, such as during an initial preventive physician exam, annual wellness visit, or comprehensive evaluation and management visit billed separately.


Feds Declare “Long COVID” a Disability - 08/17/2021

Although the pandemic rages on, there may be some relief in sight for people with lingering effects from COVID 19 infection – or “long COVID” – as well as consequences for the physicians who treat and employ them. The Biden administration in late


Modest Payment Change, New Telehealth Requirements in Proposed Medicare Fee Schedule - 07/21/2021

A proposed change to Medicare’s payment formula under the 2022 physician fee schedule, if implemented, would mean a modest payment cut for some physicians. However, the fee schedule proposal – coming in this year at a crisp 1,747 pages – includes what would be significant changes to telehealth in Medicare, among other provisions.


Medicare Proposal Offers More Flexibility for ACOs - 07/08/2021

A proposed regulation from the Centers for Medicare and Medicaid Services (CMS) would give certain accountable care organizations (ACOs) leeway to move at their own pace in graduating through the different levels of the Medicare Shared Savings Program, and the Texas Medical Association wants to ensure that flexibility sticks.


AMA Report: Medicare Physician Spending Fell Sharply During First Half of 2020; Telehealth Spending Up - 06/17/2021

Thanks to the early shutting down and shutting in prompted by COVID-19, spending on Medicare physician services fell as much as 57% short of expected levels during April 2020, and nearly one-fifth below expected spending over the first six months of that year.


Medicare Recouping COVID-19 Loans - 06/04/2021

The Centers for Medicare & Medicaid Services (CMS) recently began automatic recoupment of advance payments it made to practices during the COVID-19 pandemic, the agency announced.


Medicare Provides MIPS Relief Due to Texas Winter Storm - 06/02/2021

Certain practices affected by Texas’ statewide winter storm won’t have to submit data for Medicare’s Merit-Based Incentive Payment System (MIPS) for 2021.


Medicare Eliminates Cost Category Factor in 2020 MIPS - 06/01/2021

Medicare is continuing to acknowledge recent extraordinary events in granting physicians relief from its Merit-Based Incentive Payment System (MIPS).


MIPSperceptions: Study Confirms Doctors’ View of Medicare Program as Burdensome - 05/31/2021

Physicians’ perceptions of Medicare’s Merit-based Incentive Payment System (MIPS) have run along these and other unflattering lines since MIPS first launched in 2017. But a Physicians Foundation-funded study published in the Journal of General Internal Medicine sought to better quantify how physician practice leaders perceive MIPS, one of the two participation tracks in Medicare’s Quality Payment Program. (The Texas Medical Association has representation on the Physicians Foundation’s board of directors.)


Medicare 2% Payment Cut Suspended Through 2021 - 04/15/2021

President Joseph Biden this week extended the suspension of the Medicare sequestration, the federal government’s 2% across-the-board payment cut, through the end of the year.


Medicare as Secondary Payer - 04/08/2021

Medicare as secondary payer: Submit the primary EOB with paper claims but not with electronic claims.


Medicare Claim Errors: The Easy and the Common - 03/31/2021

Filing your Medicare claims correctly the right way every time saves time and money. Fortunately, correcting a simple mistake on a Medicare claim is easy. However you might need to invest in training if you commonly make more significant errors.


Why, What, and Who Keys to Recoupment-Proof Documentation - 03/30/2021

The lack of a signature on specific portions of an otherwise complete documentation is enough to warrant a Medicare payment recoupment. Here’s what the Centers for Medicare & Medicaid Services found in three Comprehensive Error Rate Testing reviews.


Novitas Requires Certain Forms for Paper Documentation - 03/30/2021

Novitas Solutions will return faxed or mailed documentation that is not submitted with certain approved Novitas forms.


Use Modifier AT With Tetanus Vaccine - 03/24/2021

For Medicare claims, to report the tetanus vaccine administered for  treating an injury or direct exposure to a disease or condition, append modifier AT to the code for the vaccine.


Submit 2020 Data Now to Avoid Medicare Pay Cut - 03/23/2021

If you participated in Medicare’s Quality Payment Program (QPP) under the Merit-Based Incentive Payment System (MIPS), the deadline to submit all data through the Centers for Medicare & Medicaid Services (CMS) portal has been extended one day to April 1. The deadline had been March 31.


Review Your Physician Compare Data Now - 03/23/2021

The Centers for Medicare & Medicaid Services (CMS) will close the Doctors and Clinicians Preview Period at 7 pm (CT) March 25. The preview allows you to check out your 2019 QPP performance data before its reported on Medicare Care Compare and in the Provider Data Catalog (PDC).


Use Transitional Care Management CPT Codes - 03/18/2021

Two new CPT codes for transitional care management services are in effect, and Medicare accepts them. But read the Medicare rules carefully because they vary from the CPT guide.


More Medicare Telemedicine E&M Visits Eligible for Payment, CMS Says - 03/17/2021

Practices will be able to bill for audio-only telephone evaluation and management (E&M) visits during the same month as chronic care management (CCM) visits throughout the COVID-19 public health emergency, the Centers for Medicare & Medicaid Service (CMS) has announced.