CMS is holding some provider payments
The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release. For claims with dates of service or “through...
View ArticleTemporary Delay in Implementing Ordering and Referring Denial Edits
Due to technical issues, the implementation of the Phase 2 ordering and referring denial edits is being delayed. These edits would have checked claims for an approved or validly opted-out physician or...
View ArticleICD-10 Implementation is not just Doom and Gloom
Doomsday predictions certainly abound – Heaven’s Gate, Y2K, the Mayan apocalypse – and they all came and went with a fizzle. ICD-10 has its own group of “end of the healthcare world as we know it”...
View ArticleWhat We’re Reading – Preventing duplicate claim denials
Are you experiencing more claims denials as duplicates recently? Make sure that your billing staff and/or billing company are aware that effective July 1, 2013, The Centers for Medicare & Medicaid...
View ArticleWhat We’re Reading – Manual update regarding the repayment of overpayments
If your business has ever received a demand letter from Medicare regarding overpayments, your first thought has probably been, “How am I going to pay this back while keeping my business afloat?” There...
View ArticleWhat We’re Reading – Bilateral procedures and MUEs
Are you stumped on when to use modifier 50 instead of modifiers LT and/or RT for Medicare? Modifier 50 is defined as a bilateral procedure which is performed on both sides of the body in the same...
View ArticleIs your practice utilizing the Advanced Beneficiary Notice of Noncoverage...
The Advanced Beneficiary Notice of Noncoverage, or ABN for short, is a waiver of liability that is provided to all Medicare patients if the provider believes an item/service may not be covered by...
View Article2014 Holds Big Changes for the CMS-HCC Model
The purpose of the CMS-HCC model is to improve the accuracy in predicting the costliness of Medicare Advantage (MA) enrollees’ healthcare costs and to properly fund MA plans for those expenses. It...
View ArticleHome Health Case Managers Can Save the Day
In the field of home health, the single most important individual just might be the case manager. Given the increasing pressure for all providers to assure cost-effective, high quality care, a skilled...
View ArticleWhat We’re Reading – Medicare E/M claims for new patients
Beginning on October 1, 2013, CMS will use a new claim edit to determine if more than one initial visit code was billed for a Medicare beneficiary within a three year period. This edit will also...
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