In Audit
Feb 11th, 2020
MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endoscopic procedures to the family of functional endoscopic sinus surgery (FESS) codes. Real-world Scenario Practices are now getting ...
In Audit
Jan 3rd, 2020
Coding initial hospital care became more challenging after Medicare stopped paying for inpatient consult codes several years ago — but that can’t be the only factor driving the startling error rates for evaluation and management (E/M) codes 99223 and 99214. In the report “2019 Medicare Fee-for-Service Supplemental Improper Payment Data,” the Centers for Medicare & ...
In Audit
Dec 17th, 2019
The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup as much as $5.9 billion in federal funds in 2019, The semiannual report estimates the OIG will ...
In Audit
Nov 27th, 2019
Consistent with previous reporting, the Office of Inspector General (OIG) has added to its 2020 Work Plan a targeted audit of Medicare Advantage (MA) programs for risk adjustment diagnosis codes. This is not the first time federal agency has targeted risk adjustment data. The OIG stated back in 2017, “We will review the medical record ...
In Audit
Nov 14th, 2019
Chronic care management (CCM) services are services that do not involve face-to-face patient/provider contact. The Centers for Medicare & Medicaid Services (CMS) implemented Medicare coverage for CCM in Jan. 1, 2015. There are very specific guidelines providers need to follow to be reimbursed for CCM services rendered to Medicare patients, but it appears CMS is ...