Tag Archive for ‘CMS’

The final rule on the Medicare Shared Savings Program

The Affordable Care Act (ACA) includes a provision for the Centers for Medicare & Medicaid Services (CMS) to create the Medicare Shared Savings Program (MSSP). This program would establish a payment structure for accountable care organizations (ACOs), which would be responsible for the quality, cost, and overall care of Medicare beneficiaries. CMS issued a final […]

The complexities of coding bilateral procedures

Coding for bilateral procedures is particularly challenging as the service is defined in various ways. This column addressed the complexities of coding these procedures and provides clinical case scenarios to clarify these guidelines.

Update: PQRS reporting of the perioperative care measures group

This column focuses on the Centers for Medicare & Medicaid Services’ Physician Quality Reporting System perioperative care measures group because it is the one surgeons use most frequently. First steps in reporting a claim along with denominator, frequency, and numerator topics are also covered.

Modifications to ordering and certifying rules for physicians

A major modification in the final rule recently published by the Centers for Medicare & Medicaid Services eliminates the requirement that physicians be enrolled in Medicare to order, certify, or refer the services of physician specialists. This article provides details regarding this modification and other changes in the final rule, as well as what surgeons should know about the current requirements.

Table 1: Overview of the eRx incentives and penalties for 2012 through 2014

Participating in the Medicare eRx Incentive Program

The deadline to file for a hardship exemption from the 2013 eRx Incentive Program has passed, and by now surgeons should be thinking about the requirements for the next few years. Eligible professionals who successfully e-prescribe in 2012 can qualify for an incentive payment of 1 percent.

Stakeholders’ data needs in the public reporting schematic

Public reporting of health care data: A new frontier in quality improvement

The American College of Surgeons (ACS) historically and continuously has sought to promote the highest standards of surgical care. Hence, the ACS recognizes the importance of objectively collecting, analyzing, and reporting data regarding processes of care and clinical and patient outcomes in efforts to optimize quality. The public and the government are now expressing a […]

JCR to engage surgeons and physicians to reduce adverse hospital events

Surgeons and other medical professionals want to prevent patients from being harmed during their hospital stays and to ensure that they heal without complication after they are discharged; however, accomplishing this goal can be somewhat difficult. Within the surgical continuum of care, patients may experience surgical site infections, adverse drug events, postoperative venous thromboembolism, and […]

ACS offers resources to help surgeons achieve meaningful use of EHR

In an ongoing effort to help the surgical community achieve meaningful use through participation in the federal Electronic Health Records (EHR) Incentive Program and to better understand program requirements, the American College of Surgeons (ACS) has numerous EHR resources available on the home page of its website and is engaged in a number of other […]

Table 1: Incentives and penalties under the eRx program

Participating in the Medicare eRx Incentive Program

The Centers for Medicare & Medicaid Services (CMS) Electronic Prescribing, or eRx, Incentive Program was authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). CMS defines e-prescribing as “the ability to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy from the point-of-care.” Eligible professionals (EPs) who successfully […]

Dr. Borman

Dr. Borman to serve on outpatient payment panel

Karen Borman, MD, FACS, has been appointed to the Advisory Panel on Hospital Outpatient Payment. The Centers for Medicare & Medicaid Services (CMS) announced the appointment of six new members last week. The purpose of the panel is to provide expert guidance to the Secretary of the U.S. Department of Health and Human Services (HHS) […]

PQRS reporting in 2012

The Centers for Medicare & Medicaid Services (CMS) has continued the Physician Quality Reporting System (PQRS) into 2012 as required under the Medicare Improvements for Patients and Providers Act of 2008.

CPT 2012 brings with it new codes and code changes

The Current Procedural Terminology (CPT)* 2012 manual comprises several new codes and code changes pertaining to general surgery and its closely related specialties. This article summarizes these modifications. New modifier The Affordable Care Act (ACA) requires all health care plans to begin covering immunizations and preventive services without any cost sharing. Modifier 33 has been […]


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