Tag Archives: CMS
Appeals: CMS Just Updated Medically Unlikely Edits–Do You Know How to Appeal Them?
Posted on 08. May, 2013 by rpandit.
Many MUEs make sense, but for those that don’t, you can fight back.
By now, most practices are familiar with Medicare’s medically unlikely edits (MUEs), which CMS instituted to prevent overpayments caused by gross billing errors. On April 1, CMS updated the MUE listing, and some of your favorite codes may now be limited by the bundles. When you scour your unpaid claims, make sure you are watching for MUE denials to ensure that you’re getting paid when appropriate but that you fight back when your claims are inappropriately denied.”
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Practice Management: Time to Re-Enroll Your Gynecologist? You’ll Have an Easier Job, CMS Says
Posted on 24. Apr, 2013 by rpandit.
You can fax or email the revalidation documents this time around.
If your gynecologist sees Medicare patients, re-enrolling your provider every few years is on your to-do list. The good news is that CMS has made improvements to the re-enrollment process, according to an Oct. 10 CMS National Provider Call with the agency’s Provider Enrollment Operations Group.”
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Medicare: Add to Your Add-On Code Savvy Using 3 CMS Tables
Posted on 08. Apr, 2013 by rpandit.
CCI takes note of these tables. Shouldn’t you?
CPT® doesn’t designate primary codes for every add-on code, but CMS offers a few clues in Transmittal 2636, Change Request 7501, effective April 1, 2013.
Background: An add-on code reports a service that is “always performed in conjunction with another primary service. An add-on code is eligible for payment only if it is reported with an appropriate primary procedure performed by the same practitioner. An add-on code is never eligible for payment if it is the only procedure reported by a practitioner,” states the Transmittal. “Rarely contractors may allow with appropriate submitted documentation, either pre-pay or on appeal, payment for a primary code and add-on code on two consecutive dates of service if the services are appropriately related.”
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CMS News: Update Your Revalidation Plan With New CMS Instruction
Posted on 13. Feb, 2013 by rpandit.
Kinder, gentler process forestalls ‘revocation.’
Don’t lose your ability to provide Medicare services by missing the boat on re-enrollment. Read on to see what you should do for your general surgery practice when that revalidation notice comes in the mail.
Good news: CMS has made improvements to the re-enrollment process, according to an Oct. 10 CMS National Provider Call with the agency’s Provider Enrollment Operations Group.
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Auditing: Is CMS Introducing Pre-Pay Audits in Your State?
Posted on 23. Oct, 2012 by rpandit.
Check whether your practice might come under extra scrutiny.
Here’s your latest heads up for auditing: Beginning August 27, 2012, CMS started its Recovery Audit Prepayment Review prepayment audits in 11 states. The information comes from an announcement on the CMS Web site.
| Medicare Compliance & Reimbursement The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. But you can stay on track to the changes with Medicare Compliance and Reimbursement Alert. Click here to buy. |
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Add ‘Excess Calories’ to Obesity Documentation
Posted on 11. Oct, 2012 by rpandit.
Don’t confuse ‘other’ with ‘unspecified.’
Although coding morbid obesity won’t tell the whole “medical necessity” story for lap-band procedures, you’ll need to know how to report the condition once ICD-10 is implemented.
| ICD-10 Coder Not sure how you would code for Morbid obesity when the 2014 system will be in place? Gear up for new codes for Obesity and stay in compliance with ICD-10 Coder. Click here to buy. |
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CMS: Prove Your Exemption From the E-Prescribing Penalty With New G Codes
Posted on 27. Mar, 2011 by dchandhok.
Even if you don’t have prescribing privileges, you can rest assured now as CMS will not cut your pay as a penalty for failing to comply with the new e-prescribing incentive program.
As you are probably aware, starting in 2012, you may be subject to a one percent payment adjustment on your Part B pay if you don’t successfully participate in e-prescribing this year. In 2013, that payment adjustment will go up to 1.5 percent, and in 2014 it will rise to two percent, CMS’s Daniel Green, MD noted on a Feb. 15 CMS-sponsored call.
“To earn an incentive in 2011, an eligible professional must e-prescribe 25 times during the year, ten of which must be in the first six months,” Green said. “If they are a successful e-prescriber during the calendar year, they not only would avoid the 2012 payment adjustment, they would get a
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Registration open for electronic health records incentives
Posted on 04. Jan, 2011 by dchandhok.
On Jan. 3, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) opened the registration for the Medicare and Medicaid electronic health record (EHR) incentive programs. It was started in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas and broad participation is invited from eligible professionals and eligible hospitals who wish to participate.
In February, the registration will open in
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CMS Releases 2011 Conversion Factor Rate
Posted on 28. Dec, 2010 by jennifer.godreau.
Despite adjusted rate of 33.9764, overall change is zero.
The President locked in a zero percent adjustment to your Medicare Part B payments but that doesn’t mean you’ve got the same rate.
The Medicare and Medicaid Extenders Act of 2010, which was signed into law on Dec. 15, established a payment update for 2011 of zero percent. To cover the cost of the provision, Medicare had to modify a physical therapy provision that was in the proposed 2011 Medicare Physician Fee Schedule final rule. “In addition, the final rule made other changes to the conversion factor, including a re-weighting of the work, practice expense and liability expense components of the relative value scale that resulted in a reduction in the numerical value of the conversion factor, even though
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CPT 99406, 99407 Coverage Extended to All Smokers
Posted on 31. Aug, 2010 by jennifer.godreau.
CMS announcement is triumph for physicians who haven’t collected in the past.
If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.
In the past, CMS only covered 99406-99407 (Smoking and tobacco use cessation counseling visit…) for a beneficiary with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage,
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