2019 PFS Proposal Includes E/M Coding Shakeup

Jul 18, 2018 | Physician Fee Schedule

In the past, CMS focused primarily on oversight of individual providers’ coding practices through mechanisms such as the CBRs, audits and compliance enforcement actions. But in the newly released CY2019 Physician Fee Schedule proposed rule, CMS proposes to address these issues through two general changes to outpatient and office E/M codes. Click to read more

GAO Report & CMS Announcement Focus On Medicaid Program Integrity

Jul 12, 2018 | Medicaid

A recent CMS announcement and GAO report (June 26 and June 27, respectively) highlighted the need for Medicaid program integrity. The GAO report focused on concerns identified by years of work from 2012 to 2018, while the CMS announcement highlights new initiatives to address some of these area that the GAO has identified. Click to read more.

MedPAC’s Annual June Report to Congress Revisits Long Standing Issues

Jul 11, 2018 | MedPAC

Every year, MedPAC issues a mandated June Report to Congress which analyzes developments in the Medicare program and makes recommendations for policy changes. This year’s report primarily provides analysis and additional recommendations for what are largely long-standing issues such as hospital readmissions, rural hospital and emergency department financial challenges, payment shifts from specialties to primary care, post acute payment reform, DME competitive bidding, ACOs, and management of dual eligibles. Click to read more.

More Medicare Advantage Opportunities For Providers In 2019

Jul 3, 2018 | Medicare Advantage

Medicare Advantage (MA) is a large and rapidly growing market for providers, and will provide even more opportunities in 2019. CMS will relax its supplemental benefits policies next year, allowing plans to cover more services, including non-skilled home and community-based care and transportation services. More than 21 million Medicare beneficiaries now have coverage through a private plan (which are mostly MA plans), with overall spending of $200B annually. BRG estimates that the number of Medicare beneficiaries in private plans may reach 30M by 2025. Click to read more.