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Archive for June, 2017
« Older Entries2018 MACRA PROPOSED RULE
3 days ago, CMS released the proposed changes to MACRA. I’m sure each of you have time to read all 1,052 pages, because, well, it’s just a good read. Right?
But, if you’re like most, you haven’t had time, so let’s take a quick look at the proposed 2018 MACRA changes.
- WHAT’S THE NEW PROPOSED RULE ALL ABOUT? CMS appears to be looking out for the smaller practices by proposing those participating in MIPS be exempt by changing their low-volume threshold to $90,000 or less, OR, 200 or less Medicare patients annually. If the estimate on the number of small practices this involves is right, this is great news for over 130,000 Providers!
- WHY IS CMS RELEASING SUCH A PROPOSAL? Could it be that CMS is looking out for the smaller provider by allowing more time to prepare for reporting and reducing administrative burdens? If successful, this would allow the provider to concentrate on patient care, right? It seems as though the concerns of the medical community have been heard, as discontentment has been voiced stating the burdensome paperwork required does take away from quality patient care which is (in essence) defeating the whole purpose of MACRA’s core purpose being Value-Based Care! AMA’s President, David Barbe states “This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”
CMS didn’t stop there. Other added proposals include:
- The creation of Virtual Groups which would allow small practices to combine their administrative costs by working with other small practices
- Small practices could receive extra bonus points within the Composite Performance Score for MIPS to recognize their value to the areas in which they serve
- How about adding the option for providers to use facility-based scoring for like clinicians such as hospitalists
- And, continuation of the “at your own pace” option for implementation of MIPS data reporting in 2018. This would allow for the continuing usage of the 2014-edition of Certified Electronic Health Record Technology
- Providers in small practices would have a new hardship exemption in the advancing care information data-reporting category
CMS further states, this proposed rule predicts that 80% of small practices will receive a positive or neutral payment adjustment.
CAUTION: While the proposed rule certainly offers some relief, it doesn’t make things go away. Small practices will still have significant investments to make, in order to comply with MACRA.
As your MEDICAL BILLING SERVICE, MBO will continue to keep you updated on these hot topics as they become available.
Call us at 573.634.7155 and let’s talk about how we can team up, work together and avoid any negative adjustments in your reimbursement.
2017 and HIPAA FINES
2017 has certainly brought some hefty HIPAA fines. Take a look:
January 9, 2017: Lack of timely breach notification. Fine $475,000
January 18, 2017: Impermissable disclosure of unsecured ePHI. Fine 2.2 million dollars
February 1, 2017: Lack of Timely Action. Fine 3.2 million dollars
February 16, 2017: Importance of Audit Controls. Fine 5.5 million
April 12, 2017: Overlooking Risks. Fine $400,000
April 20, 2017: No Business Associate Agreement. Fine $31,000
April 24, 2017: Not understanding HIPAA creates risks (and fines): $2.5 million
May 10, 2017: Disclosing patient information. Fine 2.4 million
May 23, 2017: Careless handling of HIV information. Fine $387,000
So far, for June, nothing reported.
MBO, your professional, established and trusted Medical Billing Service providing end-to-end Revenue Cycle Management services will always have a valid Business Associate’s Agreement in place with all clients. Give us a call at 573.634.7155 and let’s discuss what your needs are and how MBO can provide some relief.
ICD.11 Are YOU ready??
Recently, I had a panicked office manager call me about ICD.11. His concern was they’re still working through problems with ICD.10, and now they have to worry about ICD.11?
First thing that came to mind (for me) is why are you “still” having problems with ICD.10? MBO made the transition seamlessly. Of course, we prepared extensively and participated in all testing opportunities so as to address any issues before they became a problem. Tell me again, why are you having problems with ICD.10?
To address concerns about ICD.11, we first need to take a look at the journey to get to ICD.10. ICD.10 began construction in 1982 and remained in this phase until 1989. The final approval for ICD.10 came in 1990. Once approved, ICD.10 wasn’t “live” until 2015. That’s right, a span of 23 years from the beginning of constructing until the “Go Live” date in 2015. Now, back to ICD.11. The constructing of such has been in existance for about 5 years now, but it has a very lengthy process to complete before we (as providers) have to get too serious about it.
MBO, as your professional, established and trusted Medical Billing Service, providing end-to-end Revenue Cycle Management will stay on top of this and, like ICD.10, we plan to transition seamlessly so that our client can continue to focus on patient care and not be bothered with the fine details of billing. Not an MBO client? Give us a call at 573.634.7155 and find out how MBO can take your fears and turn them in to revenue!
NEW PATIENT VISITS
Seems I have had a larger than usual amount of inquiries regarding the “rules” of billing for a “New Patient Visit” vs “Established Patient”. Medicare is very clear on their interpretation of this.
WPS (Medicare) has enhanced their claims editing software with respect to new and established patients. Their policies apply the AMA (American Medical Association) and E/M (Evaluation and Management) guidelines. You run the risk of denial if you fail to follow these guidelines. Likewise, if any of your claims have passed their edits, in error, you run the risk of post audit and refund requests.
Per AMA guidelines, a new patient is defined as “one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care profession of the exact same specialty and subspecialty who belongs to the same group practice within the past three years.”
Often times, questions arise when advanced practice nurses and physician assistants are working with a physician. These professionals are considered as working in the same subspecialties as the physician. The 3 year rule still applies.
If you have questions related to this policy, please refer to the guidelines and decision tree referenced in the 2017 CPT Professional Edition.
As your Medical Billing Company, providing end-to-end Revenue Cycle Management Services, you can also direct any questions by calling us at 573.634.7155.
IRS Announces 2018 HSA Amounts
As your Medical Billing Service proving end to end Revenue Cycle Management services, we know some of our clients depend on our office for more than daily billing and coding matters. As such, we try to keep those clients abreast of any changes that may affect their private practice.
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