In Billing
Mar 14th, 2018
The Qualified Medicare Beneficiary (QMB) information in the Medicare remittance advice (RA) and Medicare summary  notice is being reintroduced; the issues preventing the processing of QMB cost-sharing claims by states and other secondary payers have been resolved. The simple fix was to include revised “alert” Remittance Advice Remark Codes in RAs for QMB claims without adopting other ...
In Audit
Feb 4th, 2018
By congressional request, the Office of Inspector General (OIG) prompted a series of audits, which investigated group home abuse and neglect of developmentally disabled residents. The findings were horrifying. According to their website, they “found that these residents often experienced serious injuries and medical conditions that resulted in emergency room visits,” and that “99 percent ...
In Billing
Dec 22nd, 2017
The Office of Inspector General (OIG) was busy in 2017. In the video, Eye on Oversight – 2017 Year in Review, released Dec. 20, the agency charged with protecting the integrity of U.S. Department of Health and Human Services (HHS) healthcare programs reflects on its accomplishments throughout the year. Summarizing the video, the OIG reports for ...
In CMS
Dec 6th, 2017
Before your healthcare organization hires on new staff, check the List of Excluded Individuals and Entities (LEIE). It’s also a good idea to verify your current employees, as well. Not checking it could put you at risk for civil monetary penalties (CMPs). Government Protecting Tax Dollars If a provider or healthcare worker or entity is ...
Follow the correct edit to promote payment and avoid denial. By Samantha Prince, BSHCM, COC, CPC, CPMA National Correct Coding Initiative (NCCI) edits for Medicare and Medicaid are not the same. If you’re following Medicare edits for Medicaid claims, you may have claims denying inappropriately. That’s missed revenue you could capture by applying the correct ...