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December 2016 Client Newsletter

Horizon Site of Service Payment Policy Change 
Lowers Physician Payments in ASCs effective December 1
On September 1, Horizon posted a notice on its website regarding changes, effective December 1, to its reimbursement policy involving site of service differential for surgical CPT codes (10000 through 69999). Effective December 1, "any setting designated as a facility by CMS will be reimbursed [by Horizon] using the facility relative value units (RVUs)." The most notable change is that Ambulatory Surgery Centers will now be designated as facilities by Horizon. While not all surgical CPT codes have lower RVUs when performed in a facility versus non-facility, it appears that payment for some procedure codes will be significantly reduced.
2017 Medicare Deductible
CMS announced on 11/10/16 that the Medicare Part B deductible will be $183, compared to $166 for 2016. 
Just a reminder that ABN's are valid for no more than 365 days for care that is rendered frequently.  Beyond 365 days, the ABN is not valid and the patient should be asked to sign a new one. 
If you are still trying to decide what to do with the Medicare Incentive programs, and need some assistance, please give Rich a call to discuss.  You don't have to become an employ of a group or merge your practice in order to survive.  You do have options.
Medicare Preventive Services
Medicare offers 21 different preventive services and in many cases, the patient does not owe a deductible or con-insurance.  For a complete listing, including the requirements for each click on this link:  Medicare Prevention Services
OIG Releases 2017 Work Plan
The Department of Health and Human Services Office of Inspector General (OIG) released its FY 2017 Work Plan, which describes OIG audits evaluations, and certain legal and investigative initiatives that are new or ongoing in FY 2017. According to the work plan, in FY 2017 and beyond, Among other items for providers, OIG will focus on Medicare payments for:
  • Transitional Care Management
  • Chronic Care Management
  • Sleep Disorder codes 95810 & 95811
  • Physician Home Visits
  • Prolonged Services
  • Power Mobility Devices
  • Ambulance Services
A copy of the Work Plan objectives was emailed to each client based on their specialty.  
2016 Client Newsletter Archive