The Medical Management Institute - MMI
The Medical Management Institute - MMI
The Medical Management Institute - MMI

MMI Updates & Announcements

  • [Announcement] Helping Small Practices Prepare for the Quality Payment Program

    Posted: Jun 25 2016

    The Quality Payment Program is proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). On June 20, HHS announced $20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer. These funds will help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. As required by MACRA, HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality...

  • [Announcement] Private Payor Prices Will Be Used By Medicare to Set Payment Rates for Clinical Diagnostic Laboratory Tests Beginning in 2018

    Posted: Jun 25 2016

    Clinical Lab Tests

    On June 17, CMS released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories. The final rule will generally require reporting entities to report private payor rates and test volumes for laboratory tests if an applicable laboratory receives at least $12,500 in Medicare revenues from laboratory services paid under the CLFS and more than 50 percent of its Medicare revenues from laboratory and/or physician services. For the system’s first year, laboratories will collect private payor data from January 1, 2016, through...

  • [Announcement] 2016 Annual Update of HCPCS Codes Use for SNF

    Posted: Jun 09 2016

    October Quarterly Update to 2016 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement › Effective Date: October 1, 2016 › Implementation Date: October 3, 2016 Provider Types Affected: This information is intended for physicians, providers, and suppliers submitting claims to all Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries who are in a Part A Skilled Nursing Facility (SNF) stay. Provider Action Needed: This information is based on Change Request (CR) 9688 updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS). Changes to Current Procedure Terminology (CPT)/HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise CWF edits to allow MACs to make appropriate payments in accordance with policy for SNF consolidated billing in the “Medicare Claims Processing Manual,” Chapter 6, Section 20.6. Make sure...

  • [Announcement] Change for the use of JW Modifier

    Posted: Jun 03 2016

    [UPDATE 6/1/2016: CMS announced a delay in implementing Change Request 9603 to January 1, 2017] Effective January 1, 2017, when processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP), local contractors shall require the use of the modifier JW to identify unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological. What is the Current Policy? The current policy allows contractors the discretion to determine whether to require the JW modifier for any claims with discarded drugs or biologicals, and the specific details regarding how the discarded drug or biological information should be documented. In order to more effectively identify and monitor billing and payment for discarded drugs and biologicals, CMS is revising this policy to require the...

  • Eight Trends in Coder Training | Originally Posted in "For the Record"

    Posted: May 15 2016

    The only constant in medical coding, is change.

    Eight Trends in Coder TrainingBy Julia Scott, RMCFor The RecordVol. 28 No. 5 P. 8 Originally posted in "For the Record"   In the world of coding, the only constant is change. Codes change, regulations change, technologies change. The list goes on. Virtually nothing stays the same for too long.  As a result, coder certification and education programs must evolve commensurate with these changes to ensure graduates are well prepared for a demanding—and dynamic—work environment. Programs that remain stagnant do a disservice to the next generation of coders who must be prepared to wear many hats and accomplish multiple tasks in the brave new world of ICD-10.  The continued spotlight on the coding profession has inspired many coder training and certification providers to reevaluate priorities, supplement content, and offer varying methods of delivery. This article explores eight trends in coder education that will play a prominent role throughout the remainder...