News & Information

On February 16, 2016, CMS, in conjunction with major commercial health plans and physician groups, released the first set of core measures, which will be used as the basis for quality-based payments. Part of the MACRA - SGR repeal was to begin to implement payment systems based on quality measures rather than the previous PPS system. This announcement marks the beginning of this process.

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NAMAS Weekly Auditing and Compliance Tips

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The PQRS program continues for 2016. CMS has recently began to publish a list of preferred measures by specialty. Keep in mind that these are preferred lists which means that there can be additional measures which apply.

The following are the CMS preferred 2016 Specialty Measure Sets:

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It turns out that there is a whole batch of new external cause codes for "Exposure to supernatural forces." They are in a new block from X40-X49.  You might want to pass this on to your contacts.  You can review the new codes here: Proposed new ICD-10 codes for 2017!

Noteworthy examples include:

X42.221_ Struck by invisible jet

X42.41 Injury due to contact with kryptonite

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By: Victoria (Tue, Mar/15/2016) 

Healthcare professionals are being forced to move out of their comfort zones. Sweeping changes are being made to change the way healthcare is provided and paid for.

40% of in-network payments are tied to value. And the traditional fee for service model is expected to disappear over the horizon in the years to come. Payments based on quality of care are increasing and it is imperative for healthcare organizations to address the current, on the ground, challenges, posed by the VBP model.

 

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