Are Your Well Woman Exam Codes Compliant with Current Billing Guidelines?

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Well-woman exams are among the most frequently performed preventive services in women's healthcare. While these visits play an essential role in preventive care, they also present significant billing and coding challenges for providers. As payer requirements continue to evolve, even small coding mistakes can result in denied claims, delayed reimbursement, compliance risks, and lost revenue. Many OBGYN practices assume their preventive visit coding is accurate until they begin experiencing increased denials or payer audits. This raises an important question: Are your Well Woman Exam codes compliant with current billing guidelines? Ensuring compliance requires more than selecting the correct CPT or diagnosis code. Providers must understand payer-specific requirements, preventive service guidelines, documentation standards, and medical necessity rules to protect reimbursement and reduce audit exposure. Why Well Woman Exam Coding Is More Complex Than It Appears At first glance, prevent...
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MACRA/MIPS Reporting in 2017: What’s in Store for 2018?

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As physicians, doctors, healthcare units, ASCs, and medical billing and coding companies observe this year’s passage of the newly laid MACRA/MIPS reporting rule, there are a lot of dilemmas about its positives and avoidance for the year 2018. However, it will be important to notice whether the final rule continues to trend toward value-based care. Also, given the intricacy and sweeping nature of QPP, it is yet to be seen whether or not positives and avoidances will alleviate administrative burden.

Understanding the MACRA/MIPS Proposed Rule

Experts, including those working in the government, who are keenly observing the scenario, have some important takeaways from the proposed rule:

  1. Around 34%-36% of physicians will be eligible for MIPS after all exclusions, although they make up 55%-58% of Medicare Part B charges.

MACRA/QPP is an enormous piece of legislation. At its business end, it will eliminate the sustainable growth rate formula and replace it with a 0.5% annual rate increase throughout 2019, after which physicians will be or will be encouraged to shift to one of the two Quality Payment Programs:

  • Merit-Based Incentive Payment System (MIPS)
  •  Alternative Payment Model (APM).
  1. The proposed scenario for the 2018 rule includes the option for providers to band together in Virtual Groups.

If you remember, this option was not available in 2017. The situation with Virtual Groups is that they allow solo practitioners or physicians in groups of 10 or fewer to combine for MIPS participation virtually. To become a Virtual Group, a solo practitioner or group must combine with at least one more solo practitioner or group, regardless of location or specialty. Make sure you register before the 2018 performance year also solo physicians must be eligible for MIPS on their own.

  1. Hospital-based doctors can now report at a facility level as well

Hospital-based physicians in the year 2018 MIPS performance period will now have the opportunity to be evaluated on quality and cost, in the context of the facilities where they practice. Such physicians can submit their facility’s in-patient value-based score to help calculate an individual score.

Experts think that such a move could be a big win for administrative simplification, as before, there was no recognition or special category for doctors who work in facilities such as a hospital.

To learn more about MACRA/MIPS Reporting in 2017: What’s in Store for 2018?, click here: https://bit.ly/46J84vg, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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