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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.…
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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…
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Reactions have been particularly negative thus far.. Outrage, disbelief, and anger tend to characterize the tone of comments regarding the Centers for Medicare & Medicaid Services’ (CMS’s) proposed evaluation and management (E&M) code changes tucked into the recently posted 2019 Medicare Physician Fee Schedule. And although CMS has indicated that…
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Multiple visits to observation patients may soon be payable but…  When one looks at the current payment structure for observation medicine from the physician viewpoint, it makes no sense. Although observation patients are not as sick as inpatients, the amount of time and number of daily visits needed to care…
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Significant – and wildly varying – changes to reimbursement loom ahead. You don’t have to be a coder to realize what the financial impact of proposed changes from the Centers for Medicare & Medicaid Services (CMS) will be, or to see that there will be winners and losers. Using 2016…
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Similar to restructuring tax brackets but then having everyone pay exactly the same single flat rate It is difficult to understand the logic underlying the proposal by the Centers for Medicare & Medicaid Services (CMS) to change dramatically the way physicians use evaluation and management (E&M) codes. On Friday July…
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Understanding the proposed CMS “Add-on” codes and their impact on reimbursement. In Part I in this article series, I discussed the proposed changes to the reimbursement for office/outpatient E&M services. We will now shift our focus to new reimbursement opportunities that the Centers for Medicare & Medicaid Services (CMS) is…
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Are procedure payments in jeopardy? While most of the attention to the 2019 Physician Fee Schedule proposed rule is focusing on the evaluation and management (E&M) changes, there are other issues which seem to be receiving much less attention than they deserve. And one of those may hit physicians’ wallets…
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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…
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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…