Medicare

CMS Finalizes Cut to Many Physician Payments, Adds Telehealth Codes in 2021 Fee Schedule - 12/04/2020

Medicare has finalized its 2021 physician fee schedule, resulting in payment cuts to many physicians due to the much-maligned budget neutrality requirements the Texas Medical Association has advocated against.


Deadline Extended: Apply for a MIPS Reporting Exemption - 12/02/2020

Did your practice face an unusual extreme hardship this year, such as financial or staffing difficulties related to COVID-19? If so, you could qualify for an exception to the Merit-Based Incentive Payment System (MIPS) reporting requirements for the 2020 performance year. The application deadline has been extended to Feb. 1, 2021. The previous deadline was Dec. 31, 2020.


2020 MIPS Data Submission Deadlines Approaching - 12/02/2020

As the year comes to a close, it’s time to start preparing to submit 2020 performance data if you participated in Medicare’s Quality Payment Program (QPP) under the Merit-Based Incentive Payment System (MIPS).


List Cost on Medicare Radiopharma Claims - 12/01/2020

When billing Medicare for radiopharmaceutical procedure codes, you must list the total acquisition cost on the claim.


Timing for Annual Medicare Mammograms - 11/20/2020

Medicare counts 11 full months after the month in which the patient received her screening


CMS Relaxes Lookback Period for Medicare Overpayments - 11/20/2020

The Centers for Medicare & Medicaid Services (CMS) has spoken, finalizing a controversial rule and relaxing the lookback period physicians must adhere to when returning Medicare overpayments. In 2012, CMS proposed requiring physicians to return Medicare overpayments going back 10 years. The agency announced last week the required lookback period will be six years.


TMA Questions QPP Data Showing Most Clinicians Will Receive Medicare Bonus in 2021 - 11/05/2020

The Centers for Medicare & Medicaid Services (CMS) has released preliminary data for the 2019 Medicare Quality Payment Program (QPP), which shows more than 95% of participating clinicians earned an incentive payment that they’ll see next year. However, Texas Medical Association experts are skeptical of the preliminary data.


CMS Announces Plans to Cover COVID-19 Vaccine - 10/29/2020

The Centers for Medicare & Medicaid Services (CMS) has released a rule to make COVID-19 vaccines available at no cost to Medicare, Medicaid, and CHIP patients.


Support Medicare Payment Parity for Another Year, TMA Tells Lawmakers - 10/26/2020

TMA is calling for passage of a bill that would require at least a one-year waiver of budget neutrality adjustments, which were part of the Centers for Medicare & Medicaid Services’ (CMS) proposed 2021 Medicare physician fee schedule, released in August.


TMA Balks at Proposed Medicare Payment Cut, More Changes to QPP During Pandemic - 10/12/2020

Physicians who renew their medical licenses after Sept. 1, 2020, are required to take one hour of CME that addresses human trafficking. TMA has now published its own CME course to educate physicians on how to identify, treat, and respond to people who are at risk or who have been trafficked.


Last Chance to Start Certain 2020 MIPS Reporting Tomorrow - 10/02/2020

If you participate in Medicare’s Quality Payment Program (QPP) under the Merit-Based Incentive Payment System (MIPS), you will have to report on the required measures – Promoting Interoperability and Improvement Activities – starting Saturday, Oct. 3.


TMA Opposes Bill Defining Clinical Psychologists as Physicians in Medicare - 09/28/2020

A broad swath of organized medicine, including the Texas Medical Association, is asking congressional leadership to oppose a bill that legally would consider clinical psychologists to be physicians within Medicare, saying it “inappropriately” expands psychologists’ scope of practice.


Code Carefully for Bilateral Procedures - 09/23/2020

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.


All Things Medicare - 09/22/2020

Need help with Medicare payment issues or with Medicare coding? Do you need information about Medicare enrollment or about participation options? Or are you looking for information about the future of Medicare – what about the payment update, new provisions in the federal Affordable Care Act, new bonuses or new compliance requirements?


The X{EPSU} Modifiers Further Define Modifier 59 - 08/13/2020

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative edits, is one you might find confusing (many practices do). Follow these guidelines


Don’t Miss New and Revised LCDs - 08/13/2020

Take a look at these new and revised Medicare local coverage determinations (LCDs) and article updates from Novitas Solutions. Remember, Novitas will reject claims that don’t adhere to LCDs.


CMS’ 2021 Fee Schedule Proposal Could Lower Physician Pay - 08/12/2020

Payments to some physicians who treat Medicare patients would fall from 2020 levels under the Centers for Medicare & Medicaid Services’ (CMS’) proposed physician fee schedule for 2021. CMS last week released the annual draft rule, which also recommends updates to the Quality Payment Program (QPP).


Can’t Say It Enough: Document, Document, Document - 08/11/2020

When Medicare delves into claims errors, one stands out: insufficient documentation.


Practice e-Tips on Medicare - 08/10/2020

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


Buying Time: Medicine’s Warnings Prompt CMS to Delay Dramatic Coding and Payment Changes - 06/23/2020

Medicine’s warnings prompt CMS to delay dramatic coding and payment changes.


Invoice No Longer Required for Some Medicare Claims - 06/03/2020

For certain biologicals and medications reported in Medicare Part B claims, Novitas Solutions now will allow you to enter invoice information on the claim, rather than provide the actual invoice for the services.


Use “Time, MDM” for Medicare Telehealth Coding - 06/02/2020

When coding for Medicare telehealth visits, you can use either medical decisionmaking (MDM) or time as the basis for your selection of office/outpatient evaluation and management (E&M) levels of service, the Centers for Medicare & Medicaid Services has clarified.


Running Out of Reasons: Low Payments, Hassles Leave Physicians Wondering: Why stay in Medicare? - 06/01/2020

Texas physicians who deal with Medicare’s substandard payments and world-class administrative hassles are feeling underappreciated. The latest report from the committee that advises Congress on Medicare payment policy may exacerbate that feeling. In March, the Medicare Payment Advisory Committee (MedPAC) released its annual report assessing payments to physicians, among other sectors. MedPAC recommended no changes to the 2021 Medicare physician fee schedule, meaning no increase in physician payments.  


Appropriate Use of Time? Medicare Rules for Advanced Imaging Orders Pose Prior-Auth Burdens - 04/09/2020

An effective way to cut down on overuse of potentially harmful imaging, or a prior authorization-esque burden on physicians who order needed tests? Texas physicians see Medicare’s “appropriate use” system for advanced imaging both ways. As of Jan. 1, physicians ordering advanced imaging tests for Medicare patients must consult an electronic portal, which evaluates whether the test meets Medicare’s own “appropriate use criteria” for whether a test should be ordered. Then when the claim is filed, physicians must document that they checked the system and its determination.  


Submit 2019 QPP Data by March 31 to Avoid a 7% Medicare Payment Cut - 03/02/2020

The data submission period for Medicare’s 2019 Quality Payment Program (QPP) is under way and closes on March 31. If you haven’t started the process, now is the time to ensure your data for the Merit-Based Incentive Payment System (MIPS) is in order and submit it in time to make corrections by the deadline, if needed.