The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for requesting an informal review for eligible professionals, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment based on their 2014 PQRS submissions. The new deadline for submission of the review request is

On November 6, 2015, the Centers for Medicare and Medicaid Services (CMS) released revised additional documentation request (ADR) limits for non-private practice settings. This would include skilled nursing facilities, home health agencies, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and hospitals. This would apply to both Part A and Part B services and Part B services would include outpatient therapy. The annual ADR Limit will be one-half of one percent (0.5%) of the provider’s total number of paid Medicare claims from the previous year. ADR letters are sent on a 45-day cycle. The annual ADR Limit will be divided by eight

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and