The Type of Service (TOS) code for CPT code 77067 for Screening Mammography will be updated to “1” (Medical Care) instead of “4” (Diagnostic Radiology). This will allow for accurate claim submission and adjudication of screening mammography. Correcting the TOS code for CPT code 77067 allows screening mammography claims to be submitted and adjudicated appropriately with no referring physician information on the claim, this is consistent with Medicare’s coverage policy for screening mammograms. Be aware that MACs...

In 2017 MACRA revoked the Sustainable Growth Rate (SGR) formula and introduced the Quality Payment Program; a payment program based on quality of care and not quantity.  The Quality Payment Program assesses clinicians on a range of performance categories including the cost category. MACRA requires the development of patient relationship categories and codes for possible use in the methodology for the cost measures. A fact sheet on the cost category can be found at https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Cost-Performance-Category-Fact-Sheet.pdf   Specifically, the...

PAMA established a new program to raise the number of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. This program requires the ordering professional to consult a qualified Clinical Decision Support Mechanism (CDSM) at the time advanced imaging services are ordered for a Medicare beneficiary. CDSMs are the electronic portals where ordering professionals can access the appropriate use criteria (AUC). CDSMs will provide the ordering professional with a determination of whether or not the...

Apply by April 30, 2018 CMS is studying burdens on clinicians associated with reporting Quality Measures under the Merit-Based Incentive Payment System (MIPS) and would like input from MIPS eligible clinicians. Clinicians who successfully participate in the study will be given full credit for the 2018 MIPS Improvement Activity (IA) category. Applications for the study will be accepted through April 30, 2018.  CMS will notify selected participants. Applicants are not required to be MIPS experts.  CMS is...

You can still avoid a 4% negative fee adjustment in payment year 2019 by submitting data for reporting year 2017 but you do not have a lot of time left to report! If you are planning on reporting for 2017 MIPS, here are some critical dates that are quickly approaching: March 1, 2018 – was the deadline for final claims to be processed for the Quality performance category via your Medicare Administrative Contractors (MACs). The claims...

 Effective January 1, 2018, payments for imaging services that are X-rays taken using computed radiography (including the technical component portion of a global service) provided during CY 2018, 2019, 2020, 2021, or 2022, will be decreased by 7 percent. For CY 2023 and subsequent years, payments will be decreased by 10 percent for these services. Computed radiography technology is defined as cassette-based imaging which utilizes an imaging plate to create the image involved. A new modifier...

Just when you think you have a proficient grasp on the new CMS Quality Payment Program-The Merit-based Incentive Payment System (MIPS) has changes in store for January 1, 2018.  There are some helpful changes such as an increase to the “Low-Volume threshold” and additional points being awarded for improvement in the Quality and cost category to name a few. There are some other changes however, that necessitate your attention such as needing a higher score...

CPT changes go into effect on 1/1/2018. A few highlights for frequently used categories are noted below. Please refer to the spreadsheet link here to review all code additions, deletions and revisions. The spreadsheet includes a summary tab and additional tabs separated by specialty. For ease of review, the code change category is noted in Column A. Radiology CPT codes 71010-71035 for x-ray of chest are being deleted and replaced with the following four CPT codes and...

Closure of NOPR (NaF-PET) on December 14, 2017  On December 15, 2015, The Centers for Medicare & Medicaid Services (CMS) issued a final decision memorandum http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=279 pertaining to the coverage of bone PET with F-18 sodium fluoride (NaF-PET) to identify bone metastasis. This National Coverage Decision (NCD) extended the requirement for coverage with evidence development (CED) under §1862(a)(1)(E) of the Social Security Act for NaF-18 PET to identify bone metastasis of cancer contained in section 220.6.19B of the...

Some Important Changes It is that time of year when we are all awaiting colder weather and anticipating the release of the final rule for CY 2018 PFS! CMS finalized revisions to payment policies under the physician fee schedule along with other revisions to Part B for the calendar year of 2018. The 2018 final rule is scheduled for publication in the Federal Register on November 16, 2017.  Below you will find some highlights to some...