Medicare

Will You Get a Medicare Bonus or Pay Cut Next Year? - 07/11/2019

 If you participated in the 2018 Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), it’s now possible to check whether you’ll receive a Medicare payment bonus or cut next year.  Physicians should check their 2018 MIPS performance feedback and 2020 payment adjustment as soon as possible in case the Centers for Medicare & Medicaid Services (CMS) made mistakes when calculating your data, which happened last year. 


Problem With Medicare’s PECOS Being Resolved, Officials Say - 07/11/2019

A software update to Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS) implemented last month has created problems associated with existing and new group reassignments. Because of this, data from PECOS to the Multi-Carrier System for these changes have been delayed for all Medicare Administrative Contractors.


False Impression: Medicine Says Medicare Report Inflates Success of Quality Program - 06/14/2019

High participation, “significant strides,” overwhelming success. That was the picture the Centers for Medicare & Medicaid Services painted in a March report on the first year of the Quality Payment Program. But a closer look by the Texas Medical Association raises serious doubts about CMS’ numbers, transparency, and cheerleading – so much so that TMA and seven other state medical associations are asking the agency to rescind the report.


Doctor’s Order A Must For Lab Tests - 05/29/2019

The Centers for Medicare & Medicaid Services is paying attention to claims for these lab services because it has found they were paid in error in 2018 by some $28 million. For routine venipuncture, medical necessity errors accounted for virtually all the improper payments. For urinalysis, it was insufficient documentation.


Medicare Muzzle? New Rules May Make Physicians Reluctant to Speak Up - 05/28/2019

New Medicare rules on local coverage determinations may make physicians reluctant to speak their minds.


Use Modifiers to Override Correct Coding Initiative Edits - 05/28/2019

Correct Coding Initiative Edits Now Free on Internet


Code Carefully for Bilateral Procedures - 05/02/2019

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.


Make Sure These Medicare Missteps Didn’t Affect Your Claims - 04/16/2019

Because of all of the policies, edits, determinations, rules, and revisions, Medicare’s claims processing sometimes goes awry for certain codes, fees, or other specific claim elements. The Centers for Medicare & Medicaid Services (CMS) reports these errors and their fixes on a regular basis.


National Specialty Societies With MACRA Information - 03/27/2019

To help you get the best information possible, TMA has identified direct links to MACRA news, resource centers, education, and advocacy from national specialty societies. Visit your specialty society online for information specific to your specialty, setting, and practice.


Security Risk Analysis for HIPAA — and Medicare/Medicaid? - 03/08/2019

Do you need to conduct a security risk analysis or review of your practice in the next 72 days?


Medicare Enrollment Application Revised - 03/04/2019

A new Medicare enrollment application form for physicians and nonphysician practitioners will go into effect May 1.


How to File a Medicare Extended Repayment Plan - 03/04/2019

  Extended repayment plans (ERPs) are an option for returning overpaid money to Medicare. Ideally, you should request an ERP immediately after receiving the initial demand letter. However, you can request an extended payment plan any time while the overpayment is outstanding. 


Watch Those Extra Fees For Medicare Patients - 03/04/2019

Watch Those Extra Fees For Medicare Patients


Use New G Codes for Medicare Therapy Claims - 03/04/2019

Starting with services dated Jan. 1, 2013, physicians have to report new, nonpayable G codes and related modifiers on Medicare claims for outpatient physical, speech, and occupational therapy.


How's Novitas Doing? - 03/04/2019

Medicare wants to know what you think of the job Novitas Solutions is doing administering the Medicare program in Texas.


Where Do We Go From Here With Our Health Care System? - 03/04/2019

To say that Medicare works well, denies the fact that in many patients are no longer able to go to the doctor of their choice. In fact, even finding a doctor is difficult. Additionally, many doctors no longer participate in the Medicare program. This program is only one step away from a single payer health care system, which was once referred to as socialized medicine.


Use Transitional Care Management CPT Codes - 01/10/2019

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.


New Options for Medicare’s 2019 Quality Payment Program - 01/08/2019

Just when you thought no one could make the Quality Payment Program any more complicated, the agency that runs the program has done just that. Beginning in 2019, the Centers for Medicare & Medicaid Services will split the QPP’s advanced alternative payment model (APM) track into two options: the original Medicare Option, and the new All-Payer Combination Option.


Review Your Physician Compare Data Before Jan. 7 - 12/20/2018

The Centers for Medicare & Medicaid Services (CMS) recently opened its Physician Compare preview period, which will allow you to check out your 2017 QPP performance data and 2016 clinician utilization data before it’s publicly reported on Physician Compare in early 2019. CMS will close the preview period on Dec. 31, so you’ll want to review your information and check for errors as soon as possible.


New Rules, Free CME: 2019 Medicare Payments - 12/18/2018

As you’ve probably seen, the Centers for Medicare & Medicaid Services released its final 2019 Medicare physician fee schedule and Quality Payment Program rule in November. TMA policy experts have analyzed the final Medicare rule and created a two-part webinar series to help practices get up to speed and in line with the latest CMS requirements.


Small Practices Can Get a Pass on MIPS Promoting Interoperability in 2018 - 12/14/2018

If your practice has 15 or fewer eligible clinicians and is experiencing some type of “significant hardship” that has created “overwhelming barriers” to complying with MIPS’ Promoting Interoperability (PI) category, you are eligible to submit a hardship application.


It’s Time to Pick Your Medicare Status - 12/12/2018

For Medicare physicians, it’s annual par/nonpar decision time. That is, you have until Dec. 31 to change your status as a participating (par) or nonparticipating (nonpar) physician in the Medicare program, starting Jan. 1. If you decide to continue with your current status, do nothing. If you want to change your status, you’ll need to notify Novitas Solutions by mail. 


MIPS Audit? Here’s What You Need to Know - 11/19/2018

Are you planning to submit data to the Merit-Based Incentive Payment System under the 2018 Quality Payment Program? If so, the Centers for Medicare & Medicaid Services could tap you for a MIPS audit in the future. Here are some things to know to prepare your practice.


Give QPP Feedback, Get MIPS Credit - 11/12/2018

Have you explored the Quality Payment Program (QPP) website lately? Did you have trouble finding what you were looking for? Did you click on all the links but leave the website with more questions than answers? If the answer is yes, tell the Centers for Medicare & Medicaid Services (CMS) all about it and get credit for the Merit-Based Incentive Payment System (MIPS) improvement activities category.


CMS Delays Dramatic Office-Visit Coding Changes Until 2021 - 11/02/2018

Following advocacy by the Texas Medical Association and much of organized medicine, the Centers for Medicare & Medicaid Services has delayed its proposal to dramatically overhaul evaluation and management coding for physician services, a proposal that TMA warned would make treating Medicare patients “even more challenging.”