In Audit
Jun 1st, 2018
If you just got one in the mail, don’t panic. Here’s why you probably received it, and how you should respond to it. The Comprehensive Error Rate Testing (CERT) program, which calculates the Medicare fee-for-service (FFS) program improper payment rate based on stratified random samples of Medicare FFS claims, continuously finds the same five leading causes ...
In Coding
Aug 16th, 2016
Noridian Healthcare Solutions is initiating a service-specific targeted review for mental health CPT® code 90834 Psychotherapy, 45 minutes with patient and/or family member. The Medicare administrative contractor (MAC) says data analysis has identified a potentially high use of this code in Jurisdiction E (California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands). Are ...
In Audit
Jul 30th, 2010
A government-led medical record review reveals that 39 percent of Medicare Part B claims allowed for mental health services during non-Part A nursing home stays in 2006 did not meet the program requirements for coverage, according to a July 8 Office of Inspector General (OIG) report. Specifically, the OIG says, services were found to be ...
In Audit
Apr 30th, 2010
George Washington University Hospital received overpayments totaling $32,000 for 39 outpatient lithotripsy services, according to an Office of Inspector General  (OIG) report. The OIG concludes in the April report that the Washington, D.C. hospital received these overpayments because it billed for the same lithotripsy service using multiple revenue codes. Excessive Lithotripsy Services Tip OIG Hat ...
In CMS
Apr 5th, 2010
The Centers for Medicare & Medicaid Services’ (CMS’) policy Change Request (CR) 6698 clarifies and updates signature guidelines for medical review purposes of the Program Integrity Manual (PIM). Meet Signature Requirements for Medical Review was last modified: July 5th, 2011 by admin aapc...