Archive for the ‘MPFS’ Category

A recent RAND Corporation study provides another incentive for physicians to implement electronic health care records (EHRs) — in addition to that really good one that mandates EHR meaningful use by 2014. According to the study, dedicated EHR use improves quality of care for patients and facilitates quality reporting for physicians. This, in turn, ensures eligible professionals (EPs) receive the full Physician Quality Reporting Initiative (PQRI) incentive. An Ingenix survey, however, says many physicians remain skeptical that the benefits would outweigh the cost of implementing an EHR system. Read more »

Highmark Medicare Services recently announced that Medicare Physician Fee Schedule (MPFS) amounts are currently unavailable on its Web site because the Center for Medicare and Medicaid Services (CMS) is expected to issue a correction.

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To ensure proper reimbursement, billing staff will need to update their standard knowledge of Advance Beneficiary Notice (ABN) modifiers. A Medicare policy revision due to take effect in 2010 changes modifier usage when reporting certain types of liability notices for non-covered services to a Medicare payer. Read more »

Cardiac computed tomography (CCT) professionals will see major changes in coding next year. CPT® 2010 adds four new Category I codes to report CCT and cardiac computed tomography angiography (CCTA) services and deletes four Category III codes.

In a statement posted on its Web site prior to the Oct. 30 release of the 2010 Outpatient Prospective Payment System (OPPS) final rule, the Society of Cardiovascular Computed Tomography (SCCT) said it did not foresee significant changes in payment for CCT/CCTA. They were singing another tune Nov. 2.

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The Centers for Medicare & Medicaid Services (CMS) announced, Oct. 30, final changes to 2010 Medicare Physician Fee Schedule (MPFS) policies and payment rates. Taking into account all changes in the final rule, CMS projects a payment increase between 5 and 8 percent for health care professionals paid under the MPFS. That’s the good news …

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If, in fact, Medicare rates for physician services are inaccurate, how might the system be improved? The Medicare Payment Advisory Commission (MedPAC) met earlier this month to answer that very question. In November, the Centers for Medicare & Medicaid Services (CMS) will look at how relative values units (RVUs) are determined during a key process known as the five-year review, which will include a public comment period.

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According to the Centers for Medicare & Medicaid Services (CMS), billing staff often do not know where their physicians performed certain services, such as diagnostic test interpretations. Either that or they simply do not understand place of service (POS) codes enough to make informed decisions.

“The use of office or POS code 11 in certain situations has been problematic,” CMS says in a recent transmittal. Read more »

The 46 percent cut in single photon emission computed tomography (SPECT) reimbursement and 22 percent inrease in positron emission tomography (PET) reimbursement the Centers for Medicare & Medicaid Services (CMS) is proposing for 2010 has some speculating a significant rise in demand for cardiac PET in the coming years. Read more »

HCPCS Level II code Q2024 Bevacizumab injection will be reimbursed by Medicare effective October 1. Distributed under the trade name Avastin, the drug inhibits angiogenesis — the uncontrolled spread of blood vessels feeding cancer tumors and diabetic retinal proliferation in the eye.

To help you code this drug, which is often administered in concert with a chemotherapeutic drug, the code’s status indicator is “E,” which means Bevacizumab is excluded from the Medicare Physician Fee Schedule Data Base (MPFSDB) by regulation and has no relative value listed, but is paid under reasonable charge procedures. Type of service (TOS) codes are “1″ (Medical Care) and “P” (lump sum purchase of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies or DMEPOS).

Read the Centers for Medicare & Medicaid Services (CMS) Transmittal 1805 to learn more.

In the last EdgeBlast issue, we reported that HCPCS Level II codes for the H1N1 vaccine and Bevacizumab injection were recently added to the Medicare Physician Fee Schedule Database (MPFSDB), but you should also note other important changes this year’s October update holds in store. Read more »