In Audit
Mar 4th, 2018
The Centers for Medicare & Medicaid Services (CMS) calculates the Medicare Fee-for-Service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Every year, CERT evaluates a statistically valid stratified random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules. A dispute may be filed ...
In Billing
Jan 18th, 2018
Palmetto GBA is preparing to become the A/B Medicare administrative contractor (MAC) for Jurisdiction J (JJ), which includes the states of Alabama, Georgia, and Tennessee — and so should you if you submit Medicare claims for healthcare providers who practice in those states. Part A providers will transition from Cahaba GBA effective Jan. 29, 2018, and Part ...
In Billing
Jan 16th, 2017
The Medicare Access and CHIP Reauthorization Act (MACRA), enacted on April 16, 2015, extended Medicare administrative contractor (MAC) contract terms from five to 10 years. The legislation also requires the Centers for Medicare & Medicaid Services (CMS) to publish performance information on each MAC, to the extent that such information does not interfere with contract ...
In Coding
Nov 14th, 2016
As with most things, when documenting in the medical record, it’s best to “get it right” the first time. And because human memory isn’t as reliable as we’d like to believe, it’s also best to document the patient encounter as it is rendered, or as shortly thereafter as possible. When amendments, corrections, or delayed entries ...
Knowing the various entities reviewing your medical records for accuracy is half the battle. Any entity that is expected to pay your claims has the right to review the documentation that (hopefully) supports the services being billed. To prepare for the inevitable, you are wise to familiarize yourself with which entities may be interested in ...