CPT II Codes / category 2CPT Category II codes are tracking codes which facilitate data collection for the purposes of performance measurement. The tracking codes are adopted and reviewed by the Performance Measures Advisory Group (PMAG). The PMAG is made up of experts in performance measurement from organizations including the AMA, NCQA, CMS, AHRQ and JCAHO.

MedPACIn 2014, the Medicare Advantage (MA) program included 3,600 plan options, enrolled more than 15.8 million beneficiaries (30 percent of all beneficiaries), and paid MA plans about $159 billion to cover Part A and Part B services.

ICD-10 RedJust as we were all making peace with the fact that ICD-10 was a forgone conclusion, the House of Representatives introduces a bill to stop the October 1 implementation.

HumanaEffective June 22, 2015, Humana will make the following modifier changes to professional claims for their commercial fully insured (including HMOx and select self-funded members), Medicaid and Medicare Advantage HMO, PPO, and private fee-for-service members. However, not all of these products will necessarily be affected by each of the payment policies or modifier updates.

Blue Cross Blue ShieldEffective June 1, 2015, BCBSNJ will make changes to their reimbursement policies for modifiers 52, 53, 54, 55, 56, and 73. The purpose of this policy is to provide guidelines for the reimbursement of eligible services appropriately appended with modifiers for participating and non-participating professional providers.

CMSThe Centers for Medicare & Medicaid Services (CMS) recently announced that the Open Payments Program (Sunshine Act) review and dispute process will begin April 6 and end May 21, 2015.

Doctor with MoneyNearly 40% of healthcare providers treating Medicare patients will have their reimbursement payments docked 1.5% this year because they didn't submit data on patients’ health to the government, the Centers for Medicare and Medicaid Services reported.

CMSOn April 16th the Centers for Medicare & Medicaid Services (CMS) introduced its first star ratings of consumer satisfaction for hospitals.

15 StatesThe Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services — but only temporarily. The federal dollars ran out on Jan. 1.