Medical Billing Blog

Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan will continue critical operations during the three-week time period Gov. Whitmer's executive order for Michigan residents to shelter-in-place that starts 12:01 a.m. Tuesday.

The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency established to advise Congress on issues affecting the Medicare program, released their latest report to Congress in early
March.

Under the Merit-based Incentive Payment System (MIPS) eligible clinicians (EC) are to report quality and cost data to CMS starting this year (2017). This data will be used to determine Medicare Quality Payment Program (QPP) adjustments (positive or negative) in 2019. Because 2017 has been designated as a “transition” year, the amount of reporting required of ECs is minimal.

President Trump promised repeatedly during the campaign to crack down on government waste, fraud and abuse, and the $590 billion a year Medicare program is a good place to start.

Since electronic medical records (EMR) have become prevalent, there has been concern whether documentation in the patient record accurately reflects medical necessity and the services provided. When I started working in the healthcare setting, we always told providers, “Not documented, not done.” Now, when I review a chart note, the question I have to ask myself is, “There is documentation, but was it done, today?” With the ability to import previously gathered information into the current note with just a few clicks, it’s possible that the information wasn’t reviewed at that specific encounter.

The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.

Medicare’s nascent value-based measurement system may not be a good indicator of which doctors provide high-quality medical care.

Physicians participating in the Merit-based Incentive Payment System have yet to receive eligibility notifications that the Centers for Medicare and Medicaid Services should have sent in December, according to the Medical Group Management Association.