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MIPSMACRA Quality Measures

Where Can I Find the MIPS/MACRA Quality Measures

MACRA’s new Merit-Based Incentive Payment System (MIPS) changes the way Medicare pays you. And unless you fully understand how to report your quality data under MIPS, your future Medicare payments will be significantly reduced (decreasing up to 4% initially, then later up to 9%). The bottom line is that your future Medicare payments will be […]
CMS and MACRA

OIG Report Says CMS Still Has Work to Do on MACRA

Although you are expected to begin gathering data for the Medicare Access and CHIP Reauthorization Act (MACRA) in 2017, a recent report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) indicated that there’s still more work to be done to ensure everyone has the tools and guidance necessary to […]
MIPS Quality Measures

5 Strategies Help You Select Your MIPS Quality Measures

As you’re gearing up for 2017, selecting the best Quality measures to report under MIPS is essential for you to be able to achieve the highest possible Final Score. This is the only way to improve your chances to receive a positive Medicare payment adjustment rather than a reduction to your future revenues. Use these […]
Medicare Claims Denied

Medicare Claims Denied For NCCI Edits

What do you do when an insurance payer denies a claim for NCCI edits, but it is contrary to the NCCI edits found on CMS’s website? Whose edit guidelines take precedence? When you are looking at NCCI verses a local coverage determination, the local coverage determination trumps the NCCI. One of the reasons for this […]
X Modifiers Over Modifier 59

When to Use X Modifiers Over Modifier 59

Consistent misuse and abuse of modifier 59 has put it on the Office of the Inspector General’s active radar. Meaning they are just waiting for you to slip up. To make matters worse, modifier 59 sub-modifiers (XE, XS, XP, XU) and varying carrier guidelines, make it even more difficult to get it right. In fact, […]
Symptoms and Confirmed Diagnoses Codes

Know When to Code for Symptoms and Confirmed Diagnoses to Support Your Claims

When you’re assigning diagnoses for a patient encounter, if you have a confirmed diagnosis, that’s what you use. You don’t need to submit the patient’s signs and symptoms too. But there are times when you need both to support your claim to receive the reimbursement you deserve. When relying on signs and symptoms codes, there […]
MACRA Final Rule Deadline

MACRA Final Rule Deadline: Submit Your Comments by Dec. 19

Although the Centers for Medicare and Medicaid Services (CMS) released the final rule under the Medicare Access and CHIP Reauthorization Act (MACRA) back in October, it’s still looking for feedback in certain areas affected by the regulation. You can still provide feedback and suggestions, but your time if running out. You must submit your comments […]
Complex Care Management

In 2017 Get Paid for the Complex Care Management You Provide

In 2016, Medicare added chronic care management (CCM, 99490) to its list of reimbursable codes. Starting Jan. 1, the agency is adding complex CCM services (99487-99489) to that list as well. But there are specific rules you must follow to get the payment you deserve. Most likely, you’re already providing these much needed extra services […]
Overtime Payment Changes

Federal Court Puts Hold on Overtime Payment Changes

The Fair Labor Standards Act (FLSA) overtime pay changes going into effect Dec. 1, previously covered in the Sept. 13 CompliancePop blog, are on hold. The U.S. District Court for Eastern Texas placed a nationwide hold on the new salary threshold of $47,476 for the FLSA overtime exemption, which postpones the rule’s implementation. This means […]