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Physician Practice Insider
Issue 1, January 10, 2017
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OIG: CMS must improve technical assistance, internal IT systems for QPP
CMS must improve its physician outreach and beef up its IT systems to successfully implement the... -
Study finds one free meal can influence physicians
A new study has found that physicians can be swayed to prescribe new prescription drugs for... -
Q&A: You’ve got questions! We’ve got answers!
Q: What is Medicaid CHIP? -
Time is of the essence for reporting complex chronic care management
Patients eligible for chronic care management services (CPT code 99490) are generally chronically... -
Payment Reform Expert Pans MSSP Track 1+
A healthcare payment reform advocate is calling on Medicare officials to shift away from agency's... -
Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017
On December 29, CMS posted a Correction Notice in the Federal Register regarding the 2017... -
Physician Practice Perspectives
Physician Practice Perspectives is filled with Medicare news, coding and billing compliance tips...
Issue 18, September 18, 2017
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Draw up a date-of-service primer for imaging, E/M services to get paid
Clarify the date-of-service rules you follow for reporting common services and you’ll... -
MIPS: The next frontier in health information technology
Health information technology is a troublesome area for many physicians, but not to the degree it... -
Physicians do an about-face on pain medications
Treating patients with chronic pain is an ongoing problem for physicians in an era where millions... -
3 ways to tighten up time in the waiting room
Get three tips to improve efficiency in your waiting room. -
Q&A: You've got questions! We've got answers!
Q. Can facilities require a patient to take a photo for the patient’s medical record? Can a... -
Q&A: You've got questions! We've got answers!
Question: We have multiple practice locations, and I have a couple of questions about the... -
5 Vital Business Signs for Medical Groups
Practice leaders explain how key metrics help groups meet their missions. -
5 Keys to Finding Physician Champions
Smart healthcare leaders recognize the importance of bringing clinical leaders to the table when... -
Revision to Publication 100-06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment
On September 1, CMS published MLN Matters 9815 to supplement CMS Medicare Financial Management... -
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018
On September 18, CMS published MLN Matters 10233, which accompanies Medicare Claims Processing... -
Clarification of the Billing of Immunosuppressive Drugs
On September 1, CMS published MLN Matters 10235 to supplement CMS Medicare Claims Processing... -
Revision to Publication 100-06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment
On September 18, CMS published revised MLN Matters 9815, which accompanies Medicare Financial...
Issue 17, September 4, 2017
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Update: E/M pay cut tied to modifier 25 affects only certain payer plans
Some providers face a fee schedule cut of 50% for E/M services billed with modifier 25... -
Study says physician rating websites not useful to consumers
A new study has found that physician rating websites are popular with consumers but offer little... -
Q&A: You've got questions! We've got answers!
Question: I work for a group of general surgeons. Quite often, our patients are brought back... -
Medicare Shared Savings ACOs save money, improve quality
With Medicare spending projected to grow to $1.4 trillion by 2027, the federal government is... -
New Website Platform for Survey and Certification Information
On Aug. 22, CMS issued a memorandum to State Survey Agency Directors regarding information related... -
October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On Aug. 25, CMS published Medicare Claims Processing Transmittal 3853, updating billing, payment...
Issue 16, August 21, 2017
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Physicians want change in prior authorization policies
The growing demands of administrative work are a major pain point for most physician practices... -
4 questions to ask about whether to hire NPPs
Do you see room in your practice for a productivity advantage? “My background is emergency... -
Q&A: You've got questions! We've got answers!
Q: Is CPT code 96416 (chemotherapy administration, IV infusion; initiation of prolonged... -
Code-specific rules take precedence over ICD-10-CM 'with' convention, 2018 coding guidelines instruct
Don’t automatically presume a link between two conditions within a combination code in cases... -
CMS rolls back joint replacement program, jettisons episode payment programs
CMS is preparing to cancel four mandatory episode payment models for common cardiac and orthopedic... -
Will next year’s MIPS rule impact your ACI reporting this year?
There's a lot going on in CMS' proposed rule for year two of the quality payment program (QPP), so... -
Product Spotlight: 2018 ICD-10-CM Expert for Physicians
Code claims accurately, prevent denials and secure every reimbursement dollar earned with the...
Issue 15, August 7, 2017
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Focus on medical-decision making, time may newly define E/M services
You may find significant changes to E/M reporting in the near future, including a pivot away from... -
Some provider-based outpatient departments could see facility rates cut in half
CMS is proposing to set payments for certain services performed by non-exempt off-campus... -
Q&A: You've got questions! We've got answers!
Q. How can chargemaster coordinators communicate updates to managers and directors? -
Creating a sketch of today's hard-working medical practice professional
Here’s a composite portrait of the current medical practice professional toiling away in one... -
OCR launches HIPAA right of access training for providers
A new video training module educates providers on patients’ right of access under HIPAA, the... -
OIG adds 14 items to its Work Plan
The HHS Office of Inspector General (OIG) has posted a second monthly update to its Work Plan. The... -
Product Spotlight: Webinar: Next Steps for MIPS: Prepare for Changes and Beat the 5% Pay Cut
Healthcare providers face a 5% pay cut if they don’t update and implement their Merit-Based...
Issue 14, July 21, 2017
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Payment changes for 340B drug discount program in 2018 OPPS proposed rule
One proposal that would have an enormous impact on a large number of hospitals is CMS&rsquo... -
Q&A: You've got questions! We've got answers!
Q. When using the newly covered non-face-to-face prolonged service codes (99358, 99359), can you... -
ICD-10 coding not being put to optimal use
In nearly two years since practices adopted the ICD-10 code set, billing and coding experts say the... -
Medical biller sentenced to four years for taking cut of physician’s fraud
A billing company's client became a co-conspirator in fraud and now a biller will spend four years... -
Actively licensed physicians up 12%
In the past six years, the actively licensed U.S. physician-to-population ratio increased from 277... -
Product Spotlight: Webinar: Maximizing Revenue Integrity Results: Streamlining Documentation and Data Across Facilities
A successful revenue integrity program and accurate documentation go hand in hand. The reports and...
Issue 13, June 26, 2017
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Small practices benefit under proposed QPP rule
More small practices can quality for exclusions from the Quality Payment Program (QPP), claim... -
Use technology when patient has delay in scheduling specialist appointment
Referring patients to specialists is fairly routine for most primary care practices, but it can be... -
Q&A: You've got questions! We've got answers!
Q. Our human resources department does not accept certificates of work absences without diagnoses... -
Final ICD-10-CM contains dozens of new, deleted codes not previewed in proposed set
Starting Oct. 1, you’ll be able to select a specific ICD-10-CM code when a patient is in... -
OIG Work Plan updates
On June 15, the OIG published information about updates to its Work Plan. To enhance transparency... -
MASS-ive settlements for new/established patient coding errors
Two medical centers in Massachusetts will pay more than $700,000 to settle allegations that they... -
Product Spotlight: 2018 ICD-10-CM Expert for Physicians
Code claims accurately, prevent denials and secure every reimbursement dollar earned with the...
Issue 12, June 12, 2017
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Dutifully document improvement activities during inaugural year of MIPS or risk payments
Take a close look at the documentation guidelines that CMS suggests for the practice improvement... -
OIG continuing to target vulnerabilities under 2-midnight rule
The Office of Inspector General’s (OIG) recently released semiannual report says... -
Q&A: You've got questions! We've got answers!
Q: Can a claim that is edited for a noncovered procedure be appealed? -
eClinicalWorks fraud settlement bad for co-conspirators ? but likely not for users
A fraud settlement by a major electronic health record (EHR) vendor with the Department of Justice... -
Social Security Removal Initiative (SSNRI) Outreach Campaign
On May 30, CMS published a press release about a new outreach campaign for its Social Security... -
Doctor-owned practices now a minority: AMA
The American Medical Association (AMA) has run the numbers and found that, for the first time since... -
Product Spotlight: JustCoding's E/M Essentials Toolkit
Medicare and other payers hold physicians responsible for correct billing and medical...
Issue 11, May 26, 2017
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New NPPES version takes more information, easier on enrollment surrogates
If you complete enrollment on behalf of your providers as part of CMS' surrogate program... -
Retail clinics redefine their roles
As retail clinics expand in number and in scope of services, they could emerge as a threat to some... -
Q&A: You've got questions! We've got answers!
Q: Did something change with the observation services Composite APC in 2016? The director of... -
Four tips for HIM pros on dealing with RACs
It’s easy to be overwhelmed by the volume of recovery auditor (RAC) requests and lose track... -
CMS again delays start of cardiac, ortho mandatory bundled payment models
Providers won’t have to worry about participating in a new set of mandatory Medicare episode... -
How to lose $387,200 in a fax
Two incidents at a health center operated by New York-based St. Luke's-Roosevelt Hospital Center... -
Product Spotlight: 2018 Complete Physician Coding Bundle
Ensure accurate and efficient ICD-10, HCPCS Level II and CPT coding in one fell swoop with the 2018...
Issue 10, May 16, 2017
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Improve clinical care with case management strategies
Case managers may not be physicians, but they are integral to the quality of patient... -
Outsourcing work now a norm for physician practices
The rapid pace of change in healthcare has made it difficult for many practices to keep up with... -
Q&A: You've got questions! We've got answers!
Q. Since our last risk analysis, we’ve added a patient portal. Do we need to include the... -
Adopt four changes to increase your success with MIPS
Be prepared to revise how your practice runs so that you can maximize your chances of earning an... -
Don’t hide from HEDIS
Practices that treat CIGNA patients: Check that pile of unopened mail. In the provider edition... -
HCPro Career Center
Post your open positions at http://jobs.hcpro.com and receive 25% off any Career Center... -
Product Spotlight: Medicare Boot Camp--Provider-Based Departments Version
The Medicare Boot Camp—Provider-Based Departments Version provides education on...
Issue 9, May 2, 2017
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AAFP proposes primary care APM
The American Academy of Family Physicians (AAFP) submitted a proposal for a new physician-focused... -
Study says telemedicine increases health costs
While proponents promote telemedicine as a way to reduce costs, a new study suggests telemedicine... -
Q&A: You've questions! We've got answers!
Q: A physician’s office called our office about a mutual patient to inquire the date the... -
Save time by letting patients set pre-visit agenda through EHR, patient portals
Give your patients the opportunity to set an agenda ahead of their office visits and you may... -
Implementation of New Influenza Virus Vaccine Code
On April 21, CMS published Transmittal 3754, which rescinds and replaces Transmittal 3754... -
Payment for Moderate Sedation Services
On April 14, CMS published Transmittal 3747 and MLN Matters 10001 to clarify... -
Medicare Boot Camp Povider-Based Departments Version
The Medicare Boot Camp—Provider-Based Departments Version provides education on...
Issue 8, April 18, 2017
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Physician group creates ethical guidelines for EHR use
The use of electronic health records (EHR) should be guided by ethical principles that put patient... -
Telemedicine still struggles to gain traction
Telemedicine is still a niche business for physician practices and one that’s been slow to... -
Q&A: You’ve got questions! We’ve got answers
Q: Can we ask patients to submit a signed document stating who their personal representative(s... -
Explore eligibility requirements and scoring standards for the first year of MIPS
The 2017 calendar year marks the beginning of a new approach to physician payment through the... -
Confronting unspecified codes after the end of the ICD-10-CM grace period
When CMS negotiated the one year of leniency with the American Medical Association, it was a bad... -
New waived tests
On April 3, CMS revised MLN Matters 9956, to accompany Transmittal 3741, published March 30, 2017... -
Product Spotlight: Certified Coder Boot Camp® Original Online
The Certified Coder Boot Camp uses a combination of online lecture, interactive course work, and...
Issue 7, April 4, 2017
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Patient agendas can improve visits
Communication and visit satisfaction increased for physicians and patients when patients type an... -
For some physicians, consolidation has its perks
The number of solo and small practices continues to dwindle in the U.S., and the pace of... -
Q&A: You’ve got questions! We’ve got answers!
Q: Do the -PO and -PN modifiers apply to Medicare Advantage? -
Alcohol and substance abuse records final rule aims to improve data sharing
The Substance Abuse and Mental Health Services Administration (SAMSHA) released a final rule... -
Billing for Advance Care Planning (ACP) claims
On March 20, CMS released MLN Matters 10000 to accompany Transmittal 3739, which was released... -
Revisions to payment policies under the Physician Fee Schedule and other revisions to Part B for CY 2017
On March 22, CMS published a Final Rule Correction in the Federal Register to correct multiple... -
Physician Credentialing: A Guide for Physician Office Staff
Covering the credentialing process for both hospitals and managed care organizations, Physician... -
HCPro, HealthLeaders Media, and DecisionHealth merge to form the H3.Group
Together as the H3.Group, our powerful brands combine three pillars of thought leadership...
Issue 6, March 21, 2017
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Physician groups sound off on ACA repeal and replace
Physician groups have weighed in on the American Health Care Act (AHCA), introduced by Republicans... -
Concierge medicine model continues to grow
Concierge medicine is still a niche industry, but in an era of decreasing reimbursements and... -
Q&A: You’ve got questions! We’ve got answers!
Q: In a provider-based department (PBD), when an injection is provided by a registered nurse (RN... -
2017 CPT update overhauls moderate sedation reporting
Coders prepared for 2017 with numerous changes to the Official Coding Guidelines for the ICD-10-CM... -
State opioid database links with EHR in pilot program
Despite the growing number of online prescription drug databases that aim to counter the misuse of... -
AHIMA practice brief offers guidance on improving care for LGBT patients
HIM and other healthcare professionals looking for best practice tips to improve care for LGTBT... -
JustCoding’s E/M Essentials Toolkit
JustCoding’s E/M Essentials Toolkit is the essential resource for every physician practice...
Issue 5, March 7, 2017
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AAFP supports commission that would study complex chronic disease care
A bill that aims to create a federal commission focuses on prevention and treatment of complex... -
Engaging patients online raises new issues
Physicians say communicating with patients online is still a challenge but that patients are... -
Q&A: You’ve got questions! We’ve got answers!
Q: Are we required to have employees change their passwords on a regular schedule? If so, how often... -
Scammers use OIG number to obtain bank account and personal information
The Office of Inspector General’s (OIG) telephone number is being spoofed in a scam that... -
Five steps for value-based oncology care success
To succeed in the transformation to value-based care, John K. Hudson, MD, and his colleagues at... -
A look at anatomy and ICD-10-CM coding for the eye
The human eye may be small—only approximately one inch in diameter on average—but it... -
Medicare Boot Camp® Physician Services Version
Physician practices are under increasing financial pressure, and Medicare accounts for a large...
Issue 4, February 21, 2017
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2016 revenue goals proved elusive for many physician practices
More than one-quarter of physician practices fell short of revenue goals in 2016, according to a... -
ACA repeal would put more pressure on practices
While most analysts agree that any substantial changes to the Affordable Care Act (ACA) are... -
Q&A: You’ve got questions! We’ve got answers!
Q: Is modifier -PN used instead of or in addition to modifier -PO in a non-excepted department? Do... -
Expanding the CDI focus to the outpatient arena
The focus for clinical documentation improvement (CDI) specialists has historically been on the... -
How to succeed in a Medicare ACO
Medicare and commercial accountable care organization (ACO) models are not created alike. -
CPT Manual moves laparoscopic ablation of uterine fibroid tumors from Category III codes
CPT has granted coders a new code, 58674 (laparoscopy, surgical, ablation of uterine fibroid(s... -
JustCoding's E/M Essentials Toolkit
JustCoding’s E/M Essentials Toolkit is the essential resource for every physician practice... -
HIM Briefings 2017 EHR benchmarking survey
HIM Briefings is conducting a benchmarking survey on EHR operationalization and use, and we would...
Issue 3, February 7, 2017
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PQRS deadlines extended
The deadlines for reporting certain 2016 electronic health record (EHR) data for the Physician... -
New report says e-cigarettes not a remedy for smoking cessation
For years, physicians have had little clear guidance for patients with questions about... -
Q&A: You’ve got questions! We’ve got answers!
Q: The Office for Civil Rights (OCR) has said that the comprehensive HIPAA audits will occur in... -
OCR updates HIPAA guidance on permissible disclosures
Providers may share information with a patient’s loved ones, regardless of whether they are... -
CMS confirms 359,000 providers to participate in alternative payment models
More than 359,000 providers will participate in CMS’ four alterative payment models, which... -
Independence at Home Demonstration Corrected Performance Year 2 Results
On January 19, CMS posted a Fact Sheet regarding the Independence at Home Demonstration, which... -
Product Spotlight: Medicare Boot Camp® Physician Services Version
Physician practices are under increasing financial pressure, and Medicare accounts for a large...
Issue 2, January 24, 2017
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Code set update leads to amnesty for physicians
Some eligible professionals (EP) and group practices will get a pass for failing to meet 2016... -
Treating chronic pain a tough task for physicians
Primary care physicians are the most common source of care for patients with chronic pain, and... -
Q&A: You’ve got questions! We’ve got answers!
Q. Are we required to use encryption on all email, or only email that contains protected health... -
The coding manager's role during the audit process
An internal coding audit program is the monitoring effort that ties together all coding management... -
New Interest Rate for Medicare Overpayments and Underpayments: 2nd Quarter FY 2017
On January 11, CMS published Transmittal 280 regarding 42 CFR Section 405.378, which provides for... -
How partnerships can bring community care to the next level
Summit Medical Group, the largest privately held multispecialty medical practice in New Jersey... -
Medicare Boot Camp® Physician Services Version
Physician practices are under increasing financial pressure, and Medicare accounts for a large...
