Tag Archive for ‘physician reimbursement’

Preparing for MACRA implementation

This column describes the reimbursement systems that will replace the sustainable growth rate formula and offers recommendations on how surgeons can prepare for the transition.

Provisions in the 2016 Medicare physician fee schedule that will affect surgical practice: An overview

This article summarizes the Medicare physician fee schedule provisions that will affect reimbursement for surgeons in 2016.

AMA HOD Annual Meeting sparks adoption of new policies

This report summarizes the topics addressed by the College’s delegation at the American Medical Association’s House of Delegates meeting in June.

Changes on the horizon for global services payment

The averted CMS policy that would have transitioned 10- and 90-day global payment codes to 0-day codes is summarized in this article, as is the legislation that will revise global payments in the coming years and the ACS’ advocacy-related role concerning these issues.

Physician Payments Sunshine Act data scheduled for release

The Physician Payments Sunshine Act, also known as Open Payments, is addressed in this month’s column, along with the registration process, types of data included in the system, the review and dispute process, and recommendations from the College.

What does the ACA mean for residents and their future practice?

Major provisions in the Affordable Care Act are described, including insurance exchanges, employer-based coverage, and quality improvement efforts with an emphasis on what they mean for residents and their future as health care providers.

The SGR repeal: How bad politics ruined sound policy

This article provides details on the Protecting Access to Medicare Act, which delays physician payment cuts resulting from the sustainable growth rate (SGR) formula and describes the politicking that prevented the passage of alternative legislation—the SGR Repeal Act—which offered a long-term solution to the Medicare physician payment problems.

Gundersen Health System studies effect of modifier 22 on reimbursement for complex operations

This article summarizes the findings of a study conducted at the Gundersen Health System, La Crosse, WI, designed to examine the use of modifier 22, its impact on reimbursement for complex surgical procedures, and the time to payment for surgeons. The authors found that use of modifier 22 resulted in payment increases for all procedures studied, but, for some operations, the time to recover charges rose as well.

Legislated mints on the pillow

Altering pay based on subjective surveys will increase costs to the medical system with no evidence that these surveys will improve the quality of care. “For government to legislate exactly what factors lead to that immeasurable connection [between patient and physician] taints the relationship with impersonal checkboxes, while adding costs to an already expensive and complex medical system with no evidence that it will increase value in American health care,” the author writes.

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.

Coding for damage-control surgery

This column explains how to correctly code for damage-control surgery using the current CPT manual including recommended CPT codes, codes to avoid, and clinical scenarios.

The inpatient list

This column describes the Centers for Medicare & Medicaid Services’ (CMS) inpatient list and CMS’ policies for payment of services that are either included or not included on this listing. Although the inpatient list directly affects Medicare reimbursement to hospitals and other patient care centers, surgeons should be aware of the inpatient list, because the inclusion of services on the list could affect their interactions with their hospitals.

Effectively using E/M codes for trauma care

This column provides coding guidance and clinical scenarios on the appropriate use of E/M codes during the care of injured or critically ill patients, including the use of critical care codes, the coordination/counseling guide as a coding alternative to the tradition documentation guidelines (“bullets”), and modifiers for coding during the global surgical period.


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