News

Condition 44 is one of three perplexing issues reviewed by the author.  Last week was a boring regulatory week, other than the continuing talk about the proposed changes to evaluation and management (E&M) coding. That continues to dominate discussions, with ongoing negativity by the physician community. Without new regulatory controversy,…
Practices need to get a handle on both their financial and RVU impacts. Recently, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would change the face of evaluation and management (E&M) codes as we have known them. Since 1992, E&M codes have been leveraged to…
The proposal is on the table as part of proposed E&M changes. By now I am sure that everyone is well aware that the Centers for Medicare & Medicaid Services (CMS) has proposed modifications to the reimbursement model for the outpatient/office evaluation and management (E&M) code sets, as well as…
Skilled service must be is reasonable and medically necessary on a daily basis. Years ago – when I was first entering healthcare and pilgrims were coming over on the Mayflower – the Centers for Medicare & Medicaid Services (CMS) initiated a sea change in the manner in which skilled nursing…
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…
CMS is proposing major changes to overhaul E&M services. As I read through more and more articles and white papers on the new proposed 2019 evaluation and management (E&M) changes, I got more rather than less confused. It feels like the Centers for Medicare & Medicaid Services (CMS) had this…
Change to the inpatient admission order considered to be major. Late last week, the Centers for Medicare & Medicaid Services (CMS) released the Inpatient Prospective Payment System Final Rule, which becomes effective on Oct. 1. It’s 2,593 pages, so get reading. I have to commend the CMS staff for their…
Major overhaul to physician reimbursement is proposed. The Centers for Medicare & Medicaid Services (CMS) revealed the proposed rule for Medicare Physician Fee Schedule (MPFS), in conjunction with the 2019 Quality Payment Program (QPP) in the Federal Register on July 27. The deadline to comment on this proposal is Sept.…