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2016 Latest News and Analysis on Part B Reimbursement and Regulation.

The Centers for Medicare and Medicaid’s switch from the fee-for-service (FFS) reimbursement to a value-based system will be one of the biggest financial adjustments that Part B providers have ever made. Staying compliant in 2016 will not be easy as you will have a host of new quality measures and updates to conform to — be it fee schedule change, Medicare documentation guidelines, submission timeframes for 2015 PQRS Data and maximizing scores for the Value-Based Modifier Program.

E/M Coding Errors Biggest Cause of Part B Problems

Moreover, the most recently-released CERT information showed that the 2014 Medicare Fee-for-Service improper payment rate went up to 12.7 percent, worse than the error rates logged in 2012 and 2013. Most of these errors were overpayments — which means $47.6 billion went out to Medicare providers in error, and it’s likely that MACs will be asking for much of that money back, if they haven’t already. Is your E/M coding error-proof?

Gear up: OIG has released its much-talked about 2016 Work Plan — which covers the agency’s plan to review Medicare claims for everything, from home visits to portable x-rays, and more.

As you move ahead in 2016, you also need to pay attention to new/revised/deleted 2016 CPT® codes, complexities of ICD-10 coding and documentation, modifier use, methods to avoid appeals, and ways to keep your practice HIPAA compliant. You need to keep up with the changes in billing and payment opportunities — Irrespective of whether you work in primary care or a specialty practice.

Why put your coding and deserved pay at risk in 2016?

Every week stay updated with 2016’s biggest coding, billing and compliance challenges, and get strategies to avoid compliance pitfalls.

Turn to a trusted resource that hundreds of your colleagues rely on: The Coding Institute’s Part B Insider. Our veteran coding and compliance editor Torrey Kim, CPC, CGSC provides great advice on mastering your biggest coding/billing challenges, along with tips to avoid major compliance pitfalls. We cut through the jargon and give you practical, fact-based instruction that you can rely on.

For more than a decade, every week Part B Insider has helped practices stay profitable by providing practical advice on CMS’ Part B directives and teaching you exactly what you need to know to comply. From CPT® changes, ICD-10 and E/M documentation tips, modifier usage advice, PQRS updates, HIPAA and other compliance issues – get everything you need to know to secure proper billing process in 2016!

Take a look at some of the hot Part B topics your peers are getting in every issue:

  • Practices lost nearly $210 million in down coded E/M visits in 2015.
  • Part B revenue enhancer: A typo can cost you thousands of dollars.
  • Billing: This MAC offers 10 methods to avoid appeals.
  • Tips on what you should do if you can’t obtain a history from a patient.
  • Physician notes: Family physician could face 10 years in prison over fabricated charts — how to avoid the same fate.
  • 3 tips help you stay sane if your EHR goes offline.
  • CPT® 2016: Get to know two new prolonged services codes you can use this year.
  • Patient privacy: Know the single biggest source of HIPAA breaches.
  • Modifier 50: CMS takes bilateral billing denials up a notch.
  • Did you follow these ICD-10 essential implementation tips? Find out.
  • Discontinued procedures: Watch the clock to know when modifier 53 might apply.
  • 3 facts you may not know about incident-to.

Subscribe now to Part B Insider for just $199.95 and get all the Part B coding and billing information you need in one source!

Benefit from some can’t miss resources available only to active subscribers:

SuperCoder’s Specialty Alert Archive: You will have access to a keyword-searchable database of Part B Insider on This allows you to look up and review more than 700 issues of your monthly newsletter.

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