Special Bulletin

EDITOR’S NOTE: The following article was originally published on the American College of Physician Advisors (ACPA) blog by the author. I never really understood how my “square peg” of work as a geriatrician was supposed to fit into the “round hole” of evaluation and management (E&M) CPT® coding with its…
Error reported by WPS/GHA  might have nationwide ramifications. Medicare Administrative Contractor (MAC) WPS GHA today confirmed that an enhancement to its Fiscal Intermediary Shared System (FISS) caused erroneous additional documentation request (ADR) letters to be sent to providers. In a posting to its website, WPS GHA reported that the error…
A proposed 50 percent reduction in claims submitted with modifier 25 is on the table. The Centers for Medicare & Medicaid Services (CMS) is proposing a 50 percent reduction in reimbursement for claims submitted using modifier 25, according to Shannon DeConda, an evaluation and management (E&M) coding expert. DeConda reported…
Changes to the inpatient admission order regulations are significant  The Centers for Medicare & Medicaid Services (CMS) has posted the 2019 Inpatient Prospective Payment (IPPS) Final Rule, which changes inpatient admission order regulations. The Final Rule was published Thursday in the Federal Register. “The inpatient admission order regulations are a…
CMS proposal is big news for ambulatory surgery centers. There is big news for ambulatory surgery centers (ASCs) as the Centers for Medicare & Medicaid Services (CMS) is proposing to allow 12 cardiac catheterization procedures to be performed in ASCs, according to the 2019 Outpatient Prospective Payment System (OPPS) proposed rule…
As expected, the Centers for Medicare & Medicaid Services (CMS) posted the 2019 Outpatient Prospective Payment System (OPPS) proposed rule online on Wednesday. And, also as expected, the document weighed in at more than 750 pages. RACmonitor contributor Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will report…
Unique opportunity. Hospitals urged to use great discretion. The Centers for Medicare & Medicaid Services (CMS) wants to know if your total knee replacement (TKR) claims have been denied. Ronald Hirsch, MD, made the announcement today during the weekly broadcast of Monitor Mondays when he reported that he has received…
CMS proposes to change physician evaluation and management (E&M) coding with a drastic overhaul. After soliciting comments from many stakeholders in the last year, the Centers for Medicare & Medicaid Services (CMS) has just proposed sweeping changes to the way physicians bill for evaluation and management (E&M) services in the…