Aug 1st, 2012
By Serine A. Haugsness, CPC The concept of risk adjustment was “born” upon passage of the Balanced Budget Act of 1997 and refined by the Beneficiary Improvement Act of 2000, which mandated that the Centers for Medicare & Medicaid Services (CMS) implement risk adjustment for Medicare Advantage organizations (MAOs) in 2004 and achieve 100 percent ...
In Billing
Jun 18th, 2012
Billing and coding guidelines for prostate molecular marker claims submitted to Palmetto GBA have changed. The Part B Medicare administrative contractor (MAC) for jurisdiction 1 (American Samoa, California, Guam, Hawaii, Nevada, and Northern Mariana Islands) has determined the service to be medically unnecessary and will not reimburse physicians for HOXD3, PTEN, and ERG molecular markers. ...