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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Why EMR Systems Are Important for MIPS


The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) changed how Medicare Part B providers would be paid. Replacing the volume-based payment system, MACRA is a performance-based system that rewards providers that give patients great value and outstanding service and care. Under MACRA, healthcare providers are eligible to join the Merit-Based Incentive Payment System (MIPS), which combines three Medicare programs into one single payment program. How MIPS Works  In the past, Medicare Part B programs had three payment options: the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program. MIPS streamlines [...]

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Mark Your Calendars: The 3 Upcoming MIPS Deadlines in 2018


The merit-based incentive program (MIPS) went into effect at the beginning of 2017. Many institutions spent the year deciding which measures to report on and setting up infrastructures to provide those reports. This new program has had many changes over the course of the last year and will continue to see changes this year as well. Not meeting the required measures means healthcare organizations will not receive maximum benefits and may even face penalties. Read this article to learn about the three most important upcoming MIPS deadlines and ensure your institution, clinic or practice can meet them. Advancing Care Information Performance [...]

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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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