A Few Highlights of 2015 & The Road Ahead

Why This Topic Matters

The article brings together multiple operational changes that can affect coding, billing, compliance, and reimbursement planning. It helps readers understand the broad policy environment surrounding diagnosis coding transition, physician payment reform, modifier use, and value-based payment methodologies.

Article Sections

1. ICD-10 Implementation

   Discusses the transition to ICD-10 and broader concerns about implementation, compliance, and payer expectations. The section frames why the change mattered for practices and health systems.

2. Repeal of SGR

   Covers the repeal of the sustainable growth rate formula and the resulting shift toward new Medicare physician payment approaches. It also introduces alternative payment models and the move toward merit-based performance programs.

3. Modifier 59

   Reviews CMS guidance on modifier policy updates and related selective modifier concepts. The section also references interaction with coding edits and broader billing compliance considerations.

4. Modifier 25

   Explains controversy around modifier 25 and the need for separately identifiable evaluation and management services in the context of procedures. The section discusses how practices may approach internal policy and documentation consistency.

5. Value Based Modifier

   Summarizes Medicare value-based payment methodology under the physician fee schedule, including group-based assessment and quality-tiering. The section also outlines the program’s timing and its relationship to other reporting and payment initiatives.