Related Stories

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.


Be On the Lookout for MIPS Audit Request - 06/25/2019

The Centers for Medicare & Medicaid Services has contracted with Guidehouse, a nationwide consulting firm, to audit physicians who participate in the Merit-Based Incentive Program, which is under the Quality Payment Program. If you submitted MIPS data for 2017 and/or 2018, you could receive a request for information via email or certified letter from Guidehouse.


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.


HIPAA Privacy and Security Audits Coming Soon - 05/30/2019

A whole new round of audits — for compliance with HIPAA privacy requirements — are set to begin in early 2013.


Get Dates of Service Right on Medicare Claims - 05/30/2019

When you a perform a Medicare service that is global, has both a professional and a technical component, or spans days or months, you need to know what date Medicare considers to be the official date of service when you file your claim. Here is some guidance from the Centers for Medicare & Medicaid Services (CMS) about coding and billing dates of service on professional claims.


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


Medicare X{EPSU} Modifiers Further Define Modifier 59 - 05/24/2019

The Centers for Medicare & Medicaid Services has established four new modifiers to define subsets of the commonly — but often mistakenly — used modifier 59.


Medicare Critical Care and Initial Hospital Services E and M Slated for Review - 05/17/2019

If you’ve been “probed and educated” twice by Novitas Solutions Inc. for high rate of claims errors regarding certain evaluation and management (E&M) services, you may receive more such review and education this summer.


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.


Guide to Insurance Overpayments and Refund Requests - 04/29/2019

Use this guide to help you and your staff properly assess refund requests from health plans.


Most Valuable Team: Managing Nonphysician Staff Efficiently Can Boost Patient Care and Bottom Line - 04/17/2019

Because state laws and insurer billing requirements governing physician delegation and supervision can be tricky to navigate, practices must stay up to date to avoid potential penalties.


Starting a Practice - 04/16/2019

Setting Up or Closing a Practice


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.


Coding Changes Affect UnitedHealthcare Prior Authorization Lists - 02/22/2019

UnitedHealthcare (UHC) has replaced and added procedure codes on its notification and prior authorization (PA) lists.