CMS

The Centers for Medicare & Medicaid Services (CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) are notifying people whose protected health information or other personally identifiable information (PII) may have been compromised in connection with Medicare administrative services provided by WPS. WPS is a CMS contractor that handles Medicare Part A/B claims and related services for CMS.

CHECK YOUR FEEDBACK REPORTS NOW! You have until October 11, 2024 to request a targeted review. Now Available: 2023 MIPS Performance Feedback, 2023 MIPS Final Score, and 2025 MIPS Payment Adjustment Information

What is new and what is happening for MIPS 2024?

If a patient that has Traditional Medicare and a secondary coinsurance, when, if ever, is it appropriate or is it payable to bill for a consultation code such as CPT 99243 or CPT 99244?

REGCLR3 Bunion Outcome – Adult and Adolescent

Updates Regarding CPT codes 11730 and 11750

“I am part of a recovery audit from CMS for using a modifier 59. Cotiviti Healthcare has been hired by CMS to review my use of modifier 59. They stated that my operative report supports documented Charcot reconstruction and the use of application of external fixator (CPT 20692) but modifier 59 was inappropriately used since both procedures were performed at the same session. Should I have used a different modifier in this situation? Is application of an external fixator (CPT 20692) not considered a separate procedure if it is performed at the same session as other reconstruction procedures?"

“Our office has decided to take the leap and do diabetic shoes for patients who see a Nurse Practitioner or a Physician’s Assistant. Has anyone had any luck with this? We are noticing that we are not hearing much about this since earlier this year.”

The net result is a decrease in payments of 3.89%. How does this break down?

Beginning in 2022, if you order Medicare Part B advanced diagnostic imaging services, you must consult appropriate use criteria (AUC) through a qualified Clinical Decision Support Mechanism (CDSM). You must also provide the information to furnishing professionals and facilities, because they must report AUC consultation information on their Medicare claims. When we use “you”, we are referring to physicians, other practitioners, and facilities ordering advanced diagnostic imaging services and/or furnishing Part B advanced diagnostic imaging services to Medicare beneficiaries and billing Medicare Administrative Contractors (MACs).