AAO announces that CMS will Accept Resubmitted Claims for CPTs 67228 and 65855

In a post on June 9 to members, the American Academy of Ophthalmology (AAO) announced that ophthalmologists who received incorrect denials for CPT codes 67228 (treatment of extensive or progressive retinopathy …, photocoagulation) related to the global period or for 65855 (trabeculoplasty by laser surgery) related to the bilateral indicator could re-submit these denied claims…

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CMS posts 2013 and 2014 ASC Quality Data

The Centers for Medicare & Medicaid Services (CMS) recently released 2013 and 2014 ASCQR (Ambulatory Surgery Center Quality Reporting) data via the “Hospital Compare” website.  The public data tables available contain facility, state, and national results for participating ASCs. CMS notes that making the data public “… allows consumers to find and compare the quality…

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CMS posts Part C Training for Organizational Determinations, Appeals, and Grievances

The Centers for Medicare & Medicaid Services (CMS) has posted Web-Based Training (WBT) on the important Part C (Medicare Advantage) organizational determinations, appeals, and grievances.  You can link to the CMS-provided training at this link and the Medicare Managed Care Manual, Chapter 13, on Appeals and Grievances here. Remember that when a service you want…

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SLT / ALT Payment Indicator Fixed

On May 20, 2016, CMS released MLN Matters MM9633 detailing the July update to the Medicare Physician Fee Schedule. Included in this update is a revision to the bilateral indicator for CPT code 65855, laser trabeculoplasty. When published in January, the bilateral indicator was set at “2” which meant that this service was considered bilateral…

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ICD-10 Updates October 1, 2016

The Centers for Disease Control (CDC) released proposed ICD-10 changes for later this year. Unlike CPT changes, which typically occur in January, diagnosis code additions, deletions, and edits occur on October 1. The final changes will be posted on the CDC website in June. A review of proposed changes affecting ophthalmology includes: Diabetic eye disease…

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Value-based Payment Modifier 2014 Results

On Monday, March 8, CMS published the results of the Value-based Payment Modifier calculations for 2016.  For groups with ten or more eligible professionals in 2014, the results identify the value of any upward adjustment to a group’s Medicare reimbursement for 2016.  It also reveals the number of groups who will see a downward adjustment…

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Hardship for Meaningful Use

On Friday, January 22, 2016, CMS published changes to the hardship exemption process associated with meaningful use attestation.  The streamlined application process applies to those seeking an exemption for 2015.  Failure to secure an exemption or failure to attest to meaningful use in 2015 will result in a penalty of 3% from the provider’s Medicare…

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Medicare Releases 2016 Physician Fee Schedule

Earlier this week, the Centers for Medicare & Medicaid (CMS), released the 2016 Medicare Physician Fee Schedule (MPFS).  You can link to the CMS file here.  The draft version of the MPFS released late in the Fall was noted by CMS to require some revisions.  All Medicare Administrative Contractors (MAC) had previously announced on their…

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Corrections to 2016 Fee Schedule

Several Medicare Administrative Contractors (MACs) have indicated that they will hold claims from January 1 through January 14 in anticipation of corrections to the 2016 Medicare Physicians Fee Schedule.  National Government Services, NGS, states: Holding of 2016 Date-of-Service Claims for Services Paid Under the 2016 Medicare Physician Fee Schedule On October 30, 2015, the CY…

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Deadline Extended for Value-Based Payment Modifier Informal Review Request

Practices of ten or more providers in 2014 were subject to the Value-Based Payment Modifier (VBM) in 2014. The Value Based Payment Modifier is a “quality and cost” program. It links directly to the PQRS program and rewards or penalizes providers for the quality and cost of care provided. As with all of the quality…

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