HAP Radiology Billing and Coding Blog

The Need for Standardized Radiology Documentation to Maximize Medicare Reimbursements

Accuracy and completeness in radiology reporting has taken on an even higher level of importance in order to maximize Medicare reimbursement. The Quality Payment Program (QPP) under MACRA highlights the necessity to meet new quality performance standards.  While the benefits of structured reporting using templates have been discussed before, including in our article Reimbursement Benefits of Structured Radiology Reporting, reporting on quality measures under the QPP has to include very specific terminology in order to receive credit for the measure.  This is an ideal time for radiologists to begin to use standardized reporting across their practice to ensure that all of the critical elements of documentation are met. 

Categories: radiology reimbursement, medicare reimbursement, MIPS, MACRA

Why the MIPS Patient-Facing Rules are Important to Radiologists

Physicians and other Eligible Clinicians (ECs) who are participating in MIPS under the MACRA rules governing Medicare payments will face requirements that differ depending on whether they are deemed to be “patient-facing” or not.  This determination will affect the Advancing Care Information (ACI) and Improvement Activities (IA) components, but not the Quality Performance component of MIPS. In this article, we’ll break-down the key considerations for radiology practices. 

Categories: radiology reimbursement, medicare reimbursement, MIPS, MACRA

Transitioning Your Radiology Practice to MIPS: Advancing Care Information

The Merit-Based Incentive Payment System (MIPS) is slowly being analyzed and absorbed by the medical community. This system, passed into law by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will begin to take effect for physician reimbursement in 2019 but those payment adjustments will be determined by performance in various categories for services rendered in 2017.  Regulations governing the application of this law have now been finalized and savvy radiology practices can begin to prepare to comply with the new system.

Categories: radiology reimbursement, medicare reimbursement, MIPS, MACRA, Quality Payment Program

Finalized MACRA Rules for 2017 Contain Some Good News for Radiologists

Earlier this year CMS published its proposed regulations that would implement the MACRA law to revamp the Medicare physician payment system. On October 14th, after consideration of over 4,000 comments about the proposed rules, CMS published the final rule that will govern the initial measurement period that begins January 1, 2017 for payment adjustments in 2019. 

Categories: radiology reimbursement, MIPS, MACRA, Quality Payment Program

Medicare Quality Reporting Rules are Changing

This year is the final reporting period under the now-familiar Physicians Quality Reporting System (PQRS). The Centers for Medicare and Medicaid Services (CMS) just announced proposed regulations that will govern new Medicare quality-reporting rules known as the Quality Payment Program (QPP) beginning in 2017.  This new system, which was enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), comprises both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).  The final rules will be published later this year, but physicians can begin now to explore whether they want to join an APM or adapt to the MIPS reporting requirements. 

Categories: radiology reimbursement, medicare reimbursement, PQRS, MIPS, MACRA, Quality Payment Program

A Program for Successful PQRS Participation for Radiology Practices – Step 7

At Healthcare Administrative Partners, our mission is to educate practices on CMS Quality Programs and provide a path to optimized performance even in the most challenging markets. This is the final installment of our series of articles, “A Program for Successful PQRS Participation for Radiology Practices,” which was specifically designed to help you maximize reimbursement and reduce compliance issues under the Physician Quality Reporting System (PQRS).  So far we’ve covered...

Categories: radiology reimbursement, medicare reimbursement, value modifier, PQRS, MIPS, MACRA

CMS Quality Initiatives – Reporting by Radiology Practices in 2016 and Beyond

Congress has mandated that the Centers for Medicare and Medicaid Services (CMS) move forward with quality-based programs and associated payment models. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, expanding the Medicare quality-reporting programs that began as a voluntary incentive ten years ago with the original Physician Quality Reporting Initiative (PQRI).  Today it is more important than ever to embrace and maximize success in these programs and be ready to move ahead as they evolve. 

Categories: radiology reimbursement, cms, PQRS, MIPS, MACRA

A Program for Successful PQRS Participation for Radiology Practices: Step 5

The reporting of quality measures to Medicare will continue to be a high priority for radiology practices in the years to come. The current Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) are integral parts of the new Merit-Based Incentive Payment System (MIPS). Medicare payments in 2019 will be the first that are computed under MIPS, which will use 2017 data collection for the calculation of the 2019 increases or decreases from the basic Medicare fee schedule.  Physicians’ participation in PQRS and VM in 2015 and 2016 will affect their reimbursement under these programs for payment years 2017 and 2018, respectively. 

Categories: radiology reimbursement, value modifier, PQRS, MIPS, MACRA

Regulatory Changes Affecting Radiology and Radiation Oncology Reimbursement in 2016

A variety of federal legislative activities during 2014 and 2015 contained rulings that will begin to affect Medicare reimbursement to physicians next year. Most recently, The Centers for Medicare and Medicaid Services (CMS) issued its Medicare Physician Fee Schedule (MPFS) Final Rule for 2016 that will govern its payments to physicians.  The overall impact of the final MPFS changes to radiology and radiation oncology practices compared with the proposed changes issued earlier this year, is estimated by CMS as follows:

 

Categories: radiology reimbursement, radiation oncology reimbursement, MPFS, value modifier, PQRS, MIPS, MACRA

What Can We Learn from the Initial Value-Based Payment Modifier Adjustment Year?

Every physician in the Medicare program will be subject to a potential adjustment of his or her Medicare fee schedule beginning in 2017 because of a provision in the Affordable Care Act known as the Medicare Value-Based Payment Modifier (VM). Physician groups of 100 or more Eligible Professionals are subject to the VM in 2015, the first time the VM is being applied since it became part of the Medicare law.  The fee schedule adjustments can be upward, neutral or downward depending on a variety of factors, and the Centers for Medicare and Medicaid Services (CMS) has issued a report summarizing the characteristics and performance of the groups subject to the 2015 results.  What can the results of this first year’s calculations tell us about what might happen in future years? 

Categories: radiology reimbursement, value modifier, PQRS, MIPS, MACRA

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