Tag: Medicare

Importance of Diagnosis & HCC Coding

    Diagnosis Coding is Becoming Increasingly Important Diagnosis coding is becoming more and more important.  The shift from volume to value, requires HCC coding for patient acuity not just diagnosis coding for medical necessity.  During the “Good Old Days” (think pre-Meaningful Use) as well as during the Meaningful Use Era, diagnoses were primarily required…


Overview of MACRA, QPP, & MIPS

MACRA is landmark, bi-partisan legislation passed by Congress.  It is designed to dramatically shift the payment of healthcare from the current Volume Based Reimbursement model to a model based on quality and cost effectiveness. MACRA repealed the flawed Sustainable Growth Rate, phased out Meaningful Use, PQRS and the Value Based Modifier programs. It created two…


Importance of E/M Outliers for Current Clients

In today’s coding environment, internal auditing is an important business process for avoiding costly repayments and other punitive measures for bad billing. Evaluation and Management (E/M) services are always highly monitored by auditors since those services represent such a large percentage of Medicare Part B billing. What to know Your internal auditors ought to be familiar with their…


Importance of E/M Outliers

In today’s coding environment, internal auditing is an important business process for avoiding costly repayments and other punitive measures for bad billing. Evaluation and Management (E/M) services are always highly monitored by auditors since those services represent such a large percentage of Medicare Part B billing. What to know Your internal auditors ought to be familiar…


Prevent 27.4 Percent Medicare Cuts: Write Your Legislators

Although the Senate has approved delaying the crippling 27.4% Medicare reimbursement cut until March 1, 2012, House leaders have stated their intention to defeat the two-month Senate bill in favor of a longer term solution. Congress still has much work to do to come up with a feasible and permanent fix to the sustainable growth rate (SGR) formula.