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In Billing
May 17th, 2022
But many of the changes to the Medicare Claims Processing System are retroactive. A quarterly update to the Medicare Physician Fee Schedule Database (MPFSDB) requires Medicare Administrative Contractors (MACs) to make several changes to their claims processing systems, many of which are effective prior to July 1. MACs are not required to search their files ...
In Billing
May 13th, 2022
Legal actions continue concerning the NSA’s independent dispute resolution process. The second interim final rule (IFR) related to the No Surprises Act (NSA) — legislation that regulates surprise billing in emergency and out-of-network healthcare settings to protect patients from unexpected medical expenses — was released in September 2021 (the September Rule) and, in part, included ...
In Billing
May 5th, 2022
A quarterly update for the Clinical Laboratory Fee Schedule (CLFS), issued May 4, includes nine new CPT® codes for proprietary laboratory analyses (PLAs). Medical coding and billing staff that process claims for lab testing should be aware of these codes and pricing. 9 New PLA Codes The following PLA (type of service 5) codes are ...
In Billing
May 3rd, 2022
Coverage would continue after 36 months. On April 22, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule under the Consolidated Appropriations Act, 2021 (CAA) that would, in part, extend Medicare coverage of immunosuppressive drugs for kidney transplant recipients. Section 402 of the CAA proposes to extend immunosuppressive drug coverage under ...
In Billing
May 2nd, 2022
Billing consultant implicated in healthcare provider’s wrongdoing. Can I be prosecuted for fraud because of my involvement in submitting a false claim? This is a common question from medical coding and billing personnel, especially when they have concerns regarding the codes and modifiers they are directed to bill relative to provided healthcare services and supplies. ...