Articles

PQRS participation is important for healthcare providers. Several types of payment adjustments may be applied depending on how well providers meet PQRS criteria. To avoid negative payment adjustments or even gain postitive payment adjustments (Value Based Modifier) by CMS, healthcare providers need to successfully participate in the CMS Physician Quality Reporting System (PQRS).

For detailed information about this program, please refer to Chapter 2.5 of the Behavioral Health DeskBook.

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The billing of "Incident To" services continues to be a problem. So much so that it is one of the items on the OIG Work Plan. The reason why it is a problem is that there are very specific rules as to when a service should be billed as "incident to" and when it should be billed separately.

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Historically, coverage of behavioral health services were very limited. If you were fortunate enough to have coverage for these types of services, they were generally paid at a lower rate than other medical benfits in your plan. Over the last decade, this disparity in coverage has changed - driven by legislative efforts. This began at the state level and over the last couple of years it has also expanded to the federal as well.

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The Health Insurance Portability and Accountability Act (HIPAA) has been around for quite some time. There are many misconceptions about HIPAA compliance that our office still gets calls about. This page is to help clear up some of these misconceptions.

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