The levels of service within an evaluation and management (E/M) visit are based on the documentation of key components, which include history, physical examination and medical decision making. The history component is comparable to telling a story and should include a beginning and some form of development to adequately describe the patient’s presenting problem. To…
According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Administrative Contractors (MACs) that process Medicare Part B claims have begun informing providers of their participation status in the Merit-Based Incentive Payment System (MIPS). This information is coming in the form of hard-copy letters that started mailing in late April and will continue…
NEW YORK—The Trump administration on Wednesday proposed changes to the Obamacare individual insurance market that insurers welcomed as a good start but that others pointed out could raise out-of-pocket cost for consumers. President Donald Trump and congressional Republicans have promised to scrap the 2010 healthcare law that is a key legacy of Democrat Barack Obama’s…
Each fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) puts out its Work Plan for the upcoming fiscal year to summarize its initiatives and priorities for new and ongoing work of HSS programs. Below is a summary of the key areas the OIG will focus on in 2017: Drug…
The FDA has released guidance for the development of biosimilars, and Medicare will cover Inflectra (infliximab-dyyb) in 2017…
On Jan. 6, Pfizer Inc. announced that the Centers for Medicare and Medicaid Services (CMS) has included payment information for INFLECTRA (infliximab-dyyb), a biosimilar to REMICADE (infliximab), in its January Average Selling Price (ASP) pricing file. This pricing took effect as of January 1, 2017. Additional claims processing information is listed in the MLN Matters…
To be an effective practice owner, it is necessary to understand the financial circumstances and environment of the practice’s operation. Well-managed practices prevent the loss of time and money. Therefore, to improve productivity and operating efficiencies, you need to have a basic understanding of billing and payment initiatives that will impact the practice’s bottom line….
The ACR and 315 other organizations have publicly said savings would not be achieved by the demonstration project and that it will reduce access to care for patients…
Medicare and other insurers are using patient satisfaction to determine provider payment. But according to one expert, rheumatologists who look at their practice with a critical eye, listen and ask their patients the right questions may improve their patient relationships and their practice…
The ACR will seek Congressional action if the Medicare Part B demonstration project proposed by the Centers for Medicare & Medicaid Services (CMS) is not significantly altered by the agency. Today, Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug, plus a 6% add-on, minus reductions required…