Healthcare Law & Policy Archive

Will You be Among the 87% Penalized under MIPS?

According to CMS data, 87% of solo providers and almost 60% of 2 – 9 provider practices are at risk of being penalized under the new Medicare-based Incentive Payment System (“MIPS”).  Don’t feel badly if you’re asking, “what is MIPS?”  — you still have time to learn about MIPS and ensure you’re not penalized. Under

Healthcare’s Worst Nightmare: Anthem Breach

According to Anthem’s website, one in nine Americans receives coverage for medical care through Anthem’s affiliated plans. Despite being a data storage powerhouse, Anthem failed to encrypt consumer data which surprisingly is not against the law. Anthem, the country’s second largest health insurer was hacked recently compromising names, birthdays, medical IDs, social security numbers etc.

HIEs – Start with the end result in mind

Health Information Exchanges or HIE is a major topic in healthcare discussions across the country.  As we move to greater use of computers to collect information on patients and treatment protocols, HIEs are the next step to utilizing that data to derive better outcomes.  For as long as I can remember, hospitals have gone to

Get the most out of your Coding Audit

Whenever the word audit is used it usually causes some anxiety.  This is especially true with some physicians who feel keeping up with the latest coding changes and still trying to manage a busy patient schedule can be an impossible task.  At MTBC, our coders have to continually educate to stay abreast of new coding

New 2013 Coordination of Care Benefits to Increase Payments to Family Physicians

The 2013 Medicare Physician Fee Schedule adds new payments for care coordination services when transferring patients to skilled nursing facilities.  The new Current Procedural Terminology (CPT) codes (99495 and 99496) are the result of efforts by the AMA to get CMS to adopt new coverage for transitional care management services, such as discussing a care

Obtaining PCP Reimbursement for Post-Discharge Transitional Care Management

If you are a primary care provider, you may be pleased to learn that Medicare will begin providing reimbursement for post-discharge transitional care management (TCM).  In particular, Medicare will pay providers between $163.91 and $230.90 for care provided in a non-facility setting (assuming that Congress acts to prevent the 26.5% cut). Other authors in this

CMS giveth and Congress (potentially) taketh away

The commotion over the 2013 Medicare Fee schedule belies the fact that some providers seek to gain an increase in the amount of their Medicare payments in 2013. Family practice physicians can potentially gain a 7% increase in their Medicare payments in 2013 taking into account new care coordination changes. This could potentially be a

2013 Medicare Physician Fee Schedule: TOP FIVE

I had the opportunity to host MTBC’s first webinar on the final 2013 Medicare Physician Fee Schedule this past Wednesday, December 5. Although we had an excellent turn out, many interested parties were unable to attend. Shortly after the webinar ended, I received a phone call from a client requesting that I share a “Top

CMS Fee Schedule Changes for Cardiology Procedure

As we approach 2013 CMS has announced major changes to many highly used CPT codes relating to cardiology procedure.  These code changes cover coronary interventions and electrophysiology.  Physicians and coders need to be aware of these changes prior to the new year. In the past when performing a coronary intervention a physician could only bill

Will Medicare reimburse you for Skyping during 2013?

In 2001, Medicare began providing reimbursement for certain procedures performed via telehealth, but the scope of those services was so limited that a small percentage of providers benefited from the new policy.  Changes in the 2013 fee schedule are poised to somewhat alter this dynamic and make it possible for  a growing percentage of providers