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What You Need to Know On November 2, the Centers for Medicare & Medicaid Services (CMS) finalized the 2022 Hospital Outpatient Prospective Payment System and ASC Payment System. CMS removed 255 ASC surgeries from the ASC payable list. Click here to
Read moreEffective June 15, 2021, Horizon Blue Cross Blue Shield (BCBS) of New Jersey has expanded their Consultation Services reimbursement policy to include commercial products and is fully aligned with Centers for Medicare & Medicaid Services for services rendered in office
Read moreWhat you need to know Hackensack Meridian Health (HMH) has reached an agreement with WellCare, the largest Medicaid managed care organization in the country. This expanded agreement will allow WellCare of New Jersey Medicaid members to access to HMH’s network
Read moreWhat you need to know Set to go into effect January 1, 2020, the Patient-Driven Groupings Model (PDGM) is the largest change to the home health reimbursement system in 20 years. It will overhaul how Medicare pays for home health.
Read moreThe following important Merit-based Incentive Payment (MIPS) dates and deadlines are fast approaching: December 31 – 2019 Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Applications Clinicians, groups, and virtual groups who believe they are eligible for these exceptions
Read moreThe Centers for Medicare & Medicaid Services’ (CMS) final 2018 Merit-Based Incentive Payment System (MIPS) Performance Year results are now available. If you participated in a MIPS Alternative Payment Model (APM) in 2018, specifically in a Medicare Shared Savings Program
Read moreThe Centers for Medicare & Medicaid Services’ (CMS) final 2018 Merit-Based Incentive Payment System (MIPS) Performance Year results are now available. If you participated in a MIPS Alternative Payment Model (APM) in 2018, specifically in a Medicare Shared Savings Program
Read moreThe Centers for Medicare & Medicaid Services’ (CMS) final 2018 Merit-Based Incentive Payment System (MIPS) Performance Year results are now available. If you participated in a MIPS Alternative Payment Model (APM) in 2018, specifically in a Medicare Shared Savings Program
Read moreWhat You Need To Know While a Security Risk Analysis (SRA) is not a Promoting Interoperability (PI) stand-alone measure for 2019, MIPS-eligible clinicians must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary
Read moreWhat You Need To Know The Centers for Medicare and Medicaid Services (CMS) has posted a new MIPS resource to the QPP Resource Library to answer questions and provide additional information on 2019 group participation in MIPS. The 2019 MIPS
Read moreWhat you need to know All practices must report the “Promoting Interoperability” category by April 2, 2019. This category is part of your overall MIPS score, which determines your additional incentive percentage reimbursement for all eligible Part B services. How to
Read moreWhat you need to know CMS requires all Medicare-eligible clinicians in 2019 to use an electronic health record that meets the 2015 certification standards. In addition, CMS has replaced quality measure “ACO-11: Use of Certified Electronic Health Record (EHR) Technology” with
Read moreWhat you need to know Several new provider types are now eligible to participate, including physical and occupational therapists, speech-language pathologists and audiologists. New low-volume threshold exclusion criterion also takes effect. Several other changes will also take effect. Four ways
Read moreWhat you need to know CMS has released the final 2019 Medicare Physician Fee Schedule rule. This rule revises the Medicare Shared Savings Program (MSSP) and allows MSSP ACOs the opportunity to extend their current agreements by six months. The
Read moreWhat you need to know Physicians who intend to submit data for the 2018 Promoting Interoperability (PI) category must complete a Security Risk Assessment (SRA) by December 31. The SRA can be completed by an outside organization or by someone
Read moreWhat you need to know Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) will begin conducting Prior Authorization & Medical Necessity Determination (PA/MND) reviews for certain specialized orthopedic surgeries, many of which may require the use of an implantable
Read moreOverview: Hackensack Meridian Health’s payment adjustment for our Medicare Shared Savings Program ACOs will decrease in 2019 as the result of corrections that the Centers for Medicare & Medicaid Services made to its scoring logic. Physician impact: Payment adjustments will take
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