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A Physician Contemplates Medicare Blended Rates Print E-mail
Written by Ira Nash, MD | KevinMD   
Tuesday, 21 August 2018 17:53
 
I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which "pocket guide" to coding I have been handed over the years, I can't seem to get it right. Even my errors are non-systematic. Sometimes I "overcode" (picking a visit level insufficiently supported by my note) and other times "undercode." And the things I get wrong are all over the map - sometimes my history lacks some "elements," sometimes my review of systems covers the wrong number of systems, sometimes my exam is shy an organ or two ... you get the idea. It is very hard to get better if you keep doing different things wrong. Of course, this begs the question why doctors should be coding as well as doctoring, but that is an issue for another day.
 
For now, my deficiency explains why I was intrigued to learn that  CMS recently proposed changing the rules governing the coding and reimbursement for physician office visits.
 

Last Updated on Tuesday, 21 August 2018 17:55
 
Does Medicare for All Make Sense? Print E-mail
Written by FHI's Week in Review   
Monday, 06 August 2018 17:56

Jeffrey Sachs, a professor and director of the Center for Sustainable Development at Columbia University, lays out the argument for Medicare for All (M4A) in an opinion piece posted to CNN.com on August 4. Dr. Sachs' analysis is flawed. In his idealized description of a Single Payer healthcare system, he overlooks several problems associated with such a scheme including: lack of innovation, lack of capital investment and unmet demand (resulting in long waiting times for healthcare services). That said, Dr. Sachs does highlight several issues that hamper our current health system...

Read more in the current issue of Week in Review>> https://conta.cc/2AMdT0o
 
Last Updated on Monday, 13 August 2018 16:51
 
Response to Medicare's Proposed 2019 E&M Payment Change Print E-mail
Written by Jean Acevedo   
Thursday, 02 August 2018 00:00
 
By now I'm sure that you have all heard about Medicare's proposed changes to Evaluation and Management (E&M) reimbursement in 2019. The majority of physicians I've spoken to are confused by Medicare's rationale and frustrated with the proposal. A change claiming to lessen the burden of physicians seems to promote the opposite for those physicians seeing primarily level 4 patients. The proposed reduction in payment could force them to see more patients to maintain similar revenue. 

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Last Updated on Friday, 03 August 2018 17:41
 
CMS Issues Slew of New Rules and Policies to Improve Patient Care, Boost Reimbursements Print E-mail
Written by FHInews   
Tuesday, 08 May 2018 15:20
 
The Centers for Medicare and Medicaid Services (CMS) has been busy pushing out proposed rules and policy changes that will impact healthcare providers and patients in a variety of ways. Among the proposals it has made is a Data Driven Patient Care Strategy that puts patients at the center of healthcare and makes data more accessible and usable in a way that not only enhances efficiency, but also improves quality while also reducing cost. As part of the strategy, CMS announced it is releasing encounter data from Medicare Advantage plans to researchers on everything from inpatient care to home health.

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Last Updated on Tuesday, 08 May 2018 15:55
 
OIG Report Finds Improper Billing for Telemedicine Services Print E-mail
Written by Vitale Health Law   
Tuesday, 24 April 2018 17:17

As the push to increase the use of telemedicine grows, so too do concerns over questionable billing practices.

In a recently released report, the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that the Centers for Medicare and Medicaid Services (CMS) paid practitioners for services that did not meet Medicare requirements.

To give you an idea of how much the use of telemedicine is growing, the OIG points out that in 2001, Medicare paid a total of $61,302 for telemedicine services. In 2015, that figure skyrocketed to $17.6 million.

Between 2014 and 2015 the watchdog agency reviewed 191,118 distant-site telemedicine claims that did not have corresponding originating site claims, totaling approximately $13.8 million.

Certain conditions must be met for providers to submit telehealth claims through Medicare Part B. For example, the originating site must be a practitioner's office or a medical facility, not in a patient's home, and the beneficiary must be located in a qualifying rural area.

OIG found that out of 100 sample claims reviewed, 31 claims did not meet Medicare requirements. It breaks down like this...

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