In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...
Apr 4th, 2017
In an ongoing effort to strengthen the Medicare Advantage and the Prescription Drug Program by supporting flexibility, efficiency, and innovation, the Center Medicare & Medicaid Services (CMS) released final updates to the Medicare Advantage and Part D Prescription Drug Program for 2018. The final policies are similar to the proposal released in February’s 2018 Advance Notice ...
In Billing
Feb 3rd, 2017
The Centers for Medicare & Medicaid Services (CMS) has released the files containing the payment amounts for Part B covered drugs for the first quarter of 2017. Medicare Part B payment limits for valid HCPCS codes that are not included in the quarterly pricing files will be determined by local Medicare contractors. Comparing the first ...
In Billing
Jan 16th, 2017
The 21st Century Cures Act, signed into law Dec. 13, 2016, changed the way certain Medicare Part B drugs infused through durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items will be paid beginning in April. Curing Improper Payments Section 5004 sets payment amounts for Part B drugs infused through DMEPOS items using the Average ...
In Billing
May 31st, 2016
Does your Medicare administrative contractor (MAC) require modifier JW Drug amount discarded/not administered to any patient on claims with discarded drugs or biologicals? Check your policy because, if it doesn’t now, it will soon. MACs have until July 5, 2016, to implement a recent revision to the Medicare Claims Processing Manual, Chapter 17, Section 40, ...