CPT E/M 2021 Book and Cards
- New codes and guideline changes to the Office and Other Outpatient E/M category
- Implementation checklist
- Detailed overview of the new E/M components
- Documentation guidance
- Specialty-specific E/M case scenarios
- Auditing tips
- E/M code lists
- Book and card combo
"Quality Payment Program" & "Physician Billing" Articles
Click on the title to see the article summary and a link to the full article.
February 9th, 2021
Why Reporting E/M Based on Time May Not Be Beneficial
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 9th, 2021
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
August 7th, 2020
Impact of 2021 Proposed Medicare Fee Schedule on Chiropractic Offices
By Wyn Staheli, Director of Research | Published August 7th, 2020
On August 3, 2020, the proposed Medicare Physician Fee Schedule for 2021 was released. This 1,355 page document includes some sweeping changes to the Medicare program. There are a few items in particular which should be noted by chiropractic offices.
June 15th, 2020
Outpatient Facility Pricing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020
Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...
April 22nd, 2020
COVID-19 Clinical Trial Participation Helps Providers Earn MIPS Credit
By Wyn Staheli, Director of Research | Published April 22nd, 2020
All healthcare providers who are currently participating in the MIPS portion of Medicare’s Quality Payment Program may want to participate in the new COVID-19 Clinical Trials improvement activity. Read more about it here.
January 6th, 2020
CMS Report on QPP Shows Increasing Involvement
By Wyn Staheli, Director of Research | Published January 6th, 2020
MIPS 2018 participation increased according to the final report issued by CMS on January 6, 2020.
March 1st, 2019
Understanding NCCI Edits
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 1st, 2019
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
February 5th, 2019
Clinical Staff vs. Healthcare Professional
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 5th, 2019
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.
Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges.
Examples of Qualified Healthcare professionals:
(NOTE: this list is not all-inclusive, please refer to your payer ...
February 1st, 2019
Attestations Teaching Physicians vs Split Shared Visits
By BC Advantage | Published February 1st, 2019 - Last Review/Update February 7th, 2019
Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...
January 14th, 2019
Q/A: Is G8730 Still Required? Are G Codes Required at all?
By Wyn Staheli, Director of Research | Published January 14th, 2019 - Last Review/Update January 21st, 2019
G8730, when is it required. Many G codes are still active and are required for non-quality reporting.
December 18th, 2018
Quality Measures Finalized for 2019
By Wyn Staheli, Director of Research | Published December 18th, 2018
CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are:
Physical therapists
Occupational therapists
Qualified speech-language pathologists
Qualified audiologists
Clinical psychologists
Registered dietitian or nutrition professionals
The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...
November 7th, 2018
Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?
By Wyn Staheli, Director of Research | Published November 7th, 2018
The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...
June 25th, 2018
Small Practices are Affected by MIPS Increased Thresholds
By Wyn Staheli, Director of Research | Published June 25th, 2018
We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part ...
June 25th, 2018
How Does the Physician Compare Website Affect You?
By Wyn Staheli, Director of Research | Published June 25th, 2018
The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ...
June 15th, 2018
The Money in MIPS
By Diana Strubler | Published June 15th, 2018 - Last Review/Update July 3rd, 2018
Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that 91% participated in the first year of the Quality Payment Program (QPP), barely squeaking by their goal of 90%....
February 1st, 2018
Using a 2015 Certified EHR in MIPS Year 2
By Diana Strubler | Published February 1st, 2018
The following information is from BC Advantage. As of Dec 31, 2017, Acumen EHR v8.0 achieved Office of the National Coordinator for Health Information Technology (ONC-Health IT) 2015 edition certification! What's a 2015 CEHRT?A CEHRT (Certified EHR Technology) is defined by CMS specifically for their incentive payment programs such as...
January 16th, 2018
Patient Relationship Codes
By Wyn Staheli, Director of Research | Published January 16th, 2018
Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following:
care episode groups
patient condition groups
patient relationship categories
Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...
January 10th, 2018
New MIPS Reporting Option for 2017 Data
By Wyn Staheli, Director of Research | Published January 10th, 2018
On January 2, 2018, CMS announced a new data submission system for eligible clinicians to report quality measures for the Quality Payment Program. Data may be submitted through the new platform on the qpp.cms.gov website. The announcement stated:
Data can be submitted and updated any time from January 2, 2018 to March ...
January 4th, 2018
CMS Launches Data Submission System for Clinicians in the Quality Payment Program
By Find-A-Code | Published January 4th, 2018
Today, the Centers for Medicare & Medicaid Services (CMS) announced that doctors and other eligible clinicians participating in the Quality Payment Program can begin submitting their 2017 performance data using a new system on the Quality Payment Program website (qpp.cms.gov). The data submission system is an improvement from the former...
January 2nd, 2018
Quality Payment Program in 2018
By Wyn Staheli, Director of Research | Published January 2nd, 2018 - Last Review/Update January 30th, 2019
I checked the government website to see if I am an eligible clinician and it says that I am not. I just don't want to get blindsided with a letter saying I will be penalized. Is there anything you would suggest or recommend that I do now to protect myself from future penalties. Thank you
December 13th, 2017
Appropriate Use Criteria for Advanced Diagnostic Imaging Services - 2018 Final Rule
By Jared Staheli | Published December 13th, 2017
What is the AUC program? From the CMS website:
Section 218(b) of the Protecting Access to Medicare Act of 2014 amended Title XVIII of the Social Security Act to add section 1834(q) directing CMS to establish a program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging ...
December 11th, 2017
Quality Payment Program Resources
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 11th, 2017
CMS posted new Merit-based Incentive Payment System (MIPS) resources on Quality Payment Program Resource Library webpage:
CMS Web Interface: Excel template for uploading sample beneficiary data with corresponding user guide and instructional video
Extreme and Uncontrollable Circumstances Fact Sheet: Overview of the policy established in the interim final rule with comment period to support clinicians affected by the California wildfires and ...
November 30th, 2017
Why You Should Stop Using ROM as an Outcome Measure
By Dr. Ron Feise, Practice Consultant and Coach with RJF Consulting - www.chiroevidence.com | Published November 30th, 2017 - Last Review/Update January 30th, 2019
We received this email from a chiropractic colleague: “I recently attended a
continuing education seminar accredited by a chiropractic college. The presenter
was talking about outcome measures and highly recommended cervical and
lumbar range of motion (ROM) as a good outcome measure for patients with
spinal conditions. But I am hesitant to use ROM, because it seems to be
inconsistent with a patient’s status.”
What does the current research demonstrate?
November 7th, 2017
Four Final Rules Affecting CMS Payments for 2018
By Wyn Staheli, Director of Research | Published November 7th, 2017
It’s a season for changes. CMS just finalized four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018
HHAs: Payment Changes for 2018
Quality Payment Program Rule for Year 2
This ...
November 6th, 2017
New Payment Rulings Could Affect You
By Wyn Staheli, Director of Research | Published November 6th, 2017
Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...
November 6th, 2017
Payment Rulings and Small Provider Practices
By Wyn Staheli, Director of Research | Published November 6th, 2017
Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...
November 3rd, 2017
Importance of Outcomes Measurements
By Wyn Staheli, Director of Research | Published November 3rd, 2017
One important component of health care reporting is the utilization of quality measures which are typically classified into one of three broad categories: structure, process, or outcome.
Structural measures define the healthcare provider’s capacity, systems, and processes (e.g., EHR use, ratio of providers to patients)
Process measures indicate what providers do to ...
September 29th, 2017
Does Every Visit Need to Document Quality and Quantity of Pain & Update the Treatment Plan?
By ChiroCode | Published September 29th, 2017 - Last Review/Update February 5th, 2019
Does every single visit need to document quality and quantity of pain and an update to the treatment plan?
September 29th, 2017
Don't do the MIPS Minimum
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published September 29th, 2017 - Last Review/Update March 4th, 2019
Doing the MIPS Minimum - Penny Wise but Pound Foolish?
Are you planning to “do the MIPS minimum” - the “Test” reporting option - in 2017 and submit the minimum amount of data possible to avoid the penalty? Perhaps every silver lining does not have a cloud, but “Pick Your Pace” sure does. Just as we cheered when the SGR was buried, only to see MIPS emerge from the grave, perhaps the “Pick Your Pace” regulations should undergo more scrutiny before we throw our hats into the air at this regulatory “reprieve.”
September 25th, 2017
Last Chance to Start Reporting MIPS
By ChiroCode | Published September 25th, 2017 - Last Review/Update February 5th, 2019
MIPS is a program that allows Medicare to collect data from providers about high quality low cost care that uses technology effectively. There are four categories and providers need to learn about the available measures so that they can pick the ones that make them look the best.
August 29th, 2017
Quality Measures for Chiropractic - 2017
By Wyn Staheli, Director of Research | Published August 29th, 2017
Performance Measurement Codes for Chiropractic:
Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year.
Pain Assessment and Follow-Up
131
ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...
August 24th, 2017
Q/A: MIPS and G Codes
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 24th, 2017 - Last Review/Update February 5th, 2019
We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good?
August 17th, 2017
Q/A: What are the Rules for a Fill-in (locum tenens) Doctor?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 17th, 2017 - Last Review/Update February 5th, 2019
A locum tenens provider is one that works in the place of the regular physician for a short duration of time. Guideline typically allows this time period to be a 60 day maximum, when a substitute doctor would be brought in to your office to cover your original doctor's actual schedule during the time he/she is absent.
Read further for more information
May 5th, 2017
Your MIPS Resources
By Evan Gwilliam, DC, MBA, BS, CPC, CCPC, CPC-I, CPMA, NCICS, MCS-P, QCC, CMHP | Published May 5th, 2017 - Last Review/Update March 5th, 2019
What is MIPS and what now?
February 27th, 2017
Opting Out of MIPS & MACRA
By ChiroCode | Published February 27th, 2017 - Last Review/Update February 8th, 2019
Question: Is it true that I can opt out of MIPS & MACRA if my part B charges are less than or equal to $30,000? If so, are the charges based on covered Medicare charges (98940, 98941, 98942) or all charges sent to Medicare? Some patients want non-covered charges sent to Medicare too.
February 6th, 2017
Quality Reporting is not Just for CMS
By Wyn Staheli, Director of Research | Published February 6th, 2017
If you thought that quality reporting is just for CMS, you are wrong. Other payers recognize the need to establish quality metrics.
January 23rd, 2017
Virtual Groups and MIPS
By Wyn Staheli, Director of Research | Published January 23rd, 2017
During the comment period of the MIPS Proposed Rule (Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models), there were some concerns about NPI and TIN usage for MIPS reporting for smaller organizations.
The following statements are from the MIPS Final ...
January 16th, 2017
Alternative Payment Models (APMs) and Advanced APMs
By Wyn Staheli, Director of Research | Published January 16th, 2017
When CMS Released the NPRM regarding the Quality Payment Program (QPP), it included two payment tracks: MIPS and Advanced Alternative Payment Models (APMs). Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs. So how do these payment models differ?
According to a fact sheet ...
December 28th, 2016
Medicare’s Quality Payment Program: Getting Paid for Value Instead of Volume
By ChiroCode | Published December 28th, 2016 - Last Review/Update February 8th, 2019
The government has become increasingly concerned with how they spend money in the healthcare sector. As part of the latest proposal to fix this, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015. This law changes reimbursement to remunerate providers more when they provide high quality care rather than just more care. It rewards value over volume. It also ends the flawed Sustainable Growth Rate (SGR) formula that had been in use to determine Medicare payment for many years. And, it combines three other quality-based programs into one. It’s biggest and lasting impact may be how it influences the way that patients select the provider they choose to see.
December 15th, 2016
CMS Announces Additional Opportunities for Clinicians Under the Quality Payment Program
By Brittney Murdock, QCC, CMCS, CPC | Published December 15th, 2016
Today, the Centers for Medicare & Medicaid Services (CMS) announced more new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) to improve care and earn additional incentive payments under the Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Beginning in January...
October 17th, 2016
CMS Finalizes the New Medicare Quality Payment Program
By ChiroCode | Published October 17th, 2016 - Last Review/Update March 5th, 2019
On October 14, HHS finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program.
September 9th, 2016
CMS offering options for MACRA Participation. You Choose - Be prepared!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 9th, 2016
The most recent Blog Post from CMS has given a new update on The bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS states they will allow providers four options of reporting for the first year of the program stating they can pick their pace of participation for the ...
April 13th, 2016
CMS Releases Core Quality Measures for 7 Specialties
By Wyn Staheli, Director of Research | Published April 13th, 2016
On February 16, 2016, CMS, in conjunction with major commercial health plans and physician groups, released the first set of core measures, which will be used as the basis for quality-based payments. Part of the MACRA - SGR repeal was to begin to implement payment systems based on quality measures rather than the previous PPS system. This announcement marks the beginning of this process.
January 29th, 2016
What is MIPS?
By Wyn Staheli, Director of Research | Published January 29th, 2016
The Merit-Based Incentive Payment System (MIPS) combines PQRS, VM, and EHR into a single Medicare pay-for-performance quality payment system scheduled to begin in 2019.
July 17th, 2015
Exceptions to Assignment of Provider’s Right to Payment – Claims Submitted to A/B MACs (Rev. 1931, Issued: 03-12-10)
By Find-A-Code | Published July 17th, 2015
A. Payment to Government Agency
Medicare payment for the services of a provider is not made to a governmental agency or entity except when payment to the governmental agency or entity is permissible under the other listed reassignment exceptions, e.g., where the agency is the employer of the physician.
B. Payment ...
article requests
If you would like a specific article written on a medical coding and billing topic, please contact us.
contact
innoviHealth Systems, Inc.62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
article topics
article
Thank you for choosing Find-A-Code, please Sign In to remove ads.
Quick, Current, Complete - www.findacode.com