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...

CMS declines to revisit CT colonography coverage By Eric Barnes, www.AuntMinnie.com staff writer December 15, 2016 -- In a stunning year-end setback for screening CT colonography, the U.S. Centers for Medicare and Medicaid Services (CMS) has turned down a request by advocates for CT colonography to reconsider its 2009 decision not to pay for the imaging-based colon cancer screening exam. The American College of Radiology (ACR) said it has been informed by CMS that the agency would not...

2017 is right around the corner and like every New Year we have CPT changes to review. Attached is a spreadsheet containing new/deleted codes that correspond with the chapters in the CPT manual.  The spreadsheet is tabbed by specialty or system where applicable.  This should make it easier for you to determine new and deleted codes specific to your specialty. There is also a tab for revised codes which includes a column outlining the revisions. Moderate...

January 1, 2017, is rapidly approaching and the Centers for Medicare and Medicaid Services (CMS) will be rolling out their new Quality Payment Program, specifically the Merit-Based Incentive Payment System (MIPS) and the Advanced Payment Models (APM). This year, 2016, is the last reporting period for the Physician Quality Reporting System (PQRS) as it currently exists. MIPS and APMs will go into effect January 1, 2017. The first payment adjustment based on this reporting period will...

Your ConnectiCare patients with commercial and Medicare Advantage plans effective on or after Jan. 1, 2017, will have new member ID cards. We will also be issuing new member ID numbers to all of your ConnectiCare Medicare Advantage patients. The redesigned member ID cards will make it easier for your office to identify the different product names, copayments and where you should send your claims for payment. It will also clearly note whether referrals are needed...

This is the last year for reporting of the PQRS Quality Measures as we know it today. In 2017, the Merit-Based Incentive Payment System (MIPS) will go into effect combining several programs into one. Please refer to our prior Provider News and Alert publication dated October 14, 2016 for more information. If you are submitting your 2016 PQRS Quality Measures via the claims method and are unsure if you will be a “successful reporter,” to avoid...

On Wednesday, November 2, 2016, CMS finalized revisions to payment policies under the physician fee schedule along with other revisions to Part B for calendar year 2017. These changes are scheduled to be published in the Federal Register on November 15, 2016. These revisions and regulations will be effective on January 1, 2017. Among these changes, the final rule outlines: Changes for the 2017 calendar year physician fee schedule for physician services: The current 2016 conversion...

According to the Center of Disease Control and Prevention, receiving an annual flu vaccine is the greatest method in protecting against the spread of the flu. The more people who get vaccinated, the more people who will be protected. Who should be vaccinated? All persons should receive the flu vaccine but the following groups are at high risk: Older people and those that live with and care for them Very young children and those that live with...

HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care MACRA rule will accelerate health care system’s shift toward value Today, the Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip...

Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, CMS is required to remove all Social Security Numbers from Medicare Cards by April 2019.  On September 28, 2016, CMS issued notice of its intent to discontinue the use of Social Security Numbers on Medicare cards beginning April 2018.   CMS will change to a randomly generated Medicare Beneficiary Identifier (‘MBI’) which will replace the prior SSN-based Health Insurance Claim Number (HICN).  The goal is...