The Centers for Medicare & Medicaid Services (CMS) published the CY 2018 PFS proposed rule on July 21, 2017. This proposed rule includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare PFS on or after January 1, 2018. Under the PFS, payments include services provided by physicians and other practitioners in all sites of service. Some of these services include but are not limited to visits, surgical...

CMS has made available the updated ICD-10-CM and ICD-10-PCS Code lists for 2018. These codes take effect on October 1, 2017. This summary identifies the new codes added, any revised codes, and the deleted codes. The link following this summary document will provide you with the new, revised, or deleted codes by specialty. Reminder: ICD-10 requires health professionals to code to the highest degree of specificity. SUMMARY OF CHANGES IN TOTAL: NEW CODES ADDED – 360 ...

The proposed rule for the Physician Fee Schedule (PFS) for calendar year 2018 is scheduled to be published on July 21, 2017. Within this proposal is additional information regarding the Appropriate Use Criteria (AUC) for advanced Imaging services. Evidence-based AUC for advanced imaging will assist clinicians in selecting the imaging study that is most likely to improve health outcomes for patients based on their individual clinical presentation. CMS defined qualified Clinical Decision Support Mechanisms (CDSM) as...

The 2018 proposed rule for the quality payment program (QPP) is scheduled to be published on 06/30/2017. This new program went into effect 1/1/2017 known as the transition year.  The goals of the program are to improve health outcomes of Medicare beneficiaries, spend more wisely, minimize the burden to participate and become more transparent. Below is a summary of the 2018 proposed rule related to the 4 categories included under the Merit-Based Incentive Payment System (MIPS): ...

To schedule an upgrade to version 8.2.5, contact the Meridian Support team via email at CT-Supportdept@m3meridian.com, by phone at 800.327.0955, or by entering an Mtrak ticket. This latest release includes workflow efficiencies, regulatory requirements, and client requested enhancements such as those listed here: Client Center Dissolution – For those clients currently utilizing the Client Center, the information obtained on the Client Center will be incorporated and available within VertexDr. MIPS – System previously compliant for MIPS tracking and reporting....

CMS announced this week, they are currently reviewing claims and notifying practices regarding which clinicians need to take part in the new Merit-based Incentive Payment System (MIPS). MIPS is part of the new Quality Payment Program (QPP) that went into effect January 1, 2017. The new quality program intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for providing quality care to patients. It replaces the Sustainable...

Section 218(b) of the Protecting Access to Medicare Act of 2014 added section 1834(q) directing CMS to establish a program to support the use of an appropriate use criteria (AUC) before ordering advanced diagnostic imaging services for Medicare patients. In this section of the Act, AUC are defined as criteria that are evidence-based (to the extent feasible) and assist professionals who order and provide applicable imaging services to make the most appropriate treatment decisions for...

If you are a group with 25 or more physicians and anticipate utilizing the CMS Web Interface and/or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the MIPS survey you have until June 30, 2017 to register. Registration opened on April 1, 2017. To register visit the Quality Payment Program website at https://qpp.cms.gov/learn/about-group-registration Under the new Merit-Based Incentive Payment System (MIPS), groups are defined as a single Taxpayer Identification Number (TIN) with two...

NGS Part B providers are being informed of an upcoming change to Evaluation and Management documentation expectations for expanded problem focused and detailed exams. This change will take effect on July 1, 2017. Currently the documentation requirements for both expanded problem focused and detailed exams are the same: 2 – 7 body areas or organ systems. This has caused considerable confusion within the provider community. The table below outlines the current requirements and clarifies the requirements on...

With the new CPT code set for 2017, came changes to the codes for diagnostic and screening mammography. Prior to 2017, two codes were needed to report diagnostic or screening mammography. Effective 1/1/2017, there are now just three codes which include computer-aided detection (CAD) when performed. Codes 77051, 77052 and 77055 -77057 were deleted. United Healthcare updated their Breast Imaging policy on 1/13/2017 to include CAD when performed for diagnostic and screening mammography. These changes went into...