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New CCI Edits from CMS – January 1, 2020 Updates

2020-01-03T17:46:07+00:00Billing Software, Compliance, ICD-10, MACRA, MIPS|

Important Information Regarding New CCI Edits from CMS Effective January 1st, 2020 CMS implemented new CCI edits.  Included in the new set of edits are several significant changes for Therapy CPT codes 97150 and 97530 are now listed as a Column 1 code with all of the PT and OT evaluation and reevaluation codes (97161-97168) and are not permitted to be billed on the same day as a PT or OT evaluation There is a new edit requiting a modifier 59 for CPT 97140 when billed with PT or OT evaluation Raintree has included these new CCI edits in [...]

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5 Steps to Start Preparing Your Medical Business for MACRA

2019-02-28T18:21:37+00:00MACRA|

The Medicare Access and CHIP Reauthorization Act (MACRA) was enacted in 2015 with the goal of creating a flexible, unified program for reimbursing physicians under two value-based payment tracks – the Merit Based Incentive Payment System (MIPS) and the Alternative Payment Model (AMP) According to CMS.gov, the purpose of MACRA is to create a quality based payment program that: Repeals the Sustainable Growth Rate formula Changes the way that Medicare rewards clinicians for value over volume Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS) Gives bonus payments for participation in eligible alternative payment models (APMs) Beginning [...]

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A Guide to the Most Important MACRA Information

2017-05-10T17:02:09+00:00MACRA, MIPS, News|

By understanding more about the changes implemented by the latest Medicare reform, medical specialists can ensure their organization remains in compliance. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) sets out the refined standards for billing patients and seeks to reward specialists for providing quality of service. In this latest post, we’ll provide more in-depth details on MACRA and the changes the legislation requires from the modern practice. What is MACRA? MACRA is the legislation that has introduced changes to the clinician payment system under Medicare. The act displaces the Sustainable Growth Rate formula, which determined reimbursement rates for [...]

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