In Billing
Feb 8th, 2019
If your 2019 Medicare Part B claims payments aren’t adding up as expected, there may be a good explanation: the Centers for Medicare & Medicaid Services goofed. The agency recently discovered that an error in the implementation of the 2019 Merit-based Incentive Payment System (MIPS) payment adjustment was causing Medicare Part B drugs and other ...
In the Medicare Physician Fee Schedule (MPFS) proposed rule for 2019 payment policies, the Centers for Medicare & Medicaid Services (CMS) introduces radical changes to the way healthcare practitioners would be reimbursed for evaluation and management (E/M) services furnished to their Medicare Part B patients beginning in 2019. At the crux of the debate that ensued with the ...
In Billing
Feb 7th, 2018
Many quality measures in the Quality Payment Program include ICD-10-CM codes in either the numerator, denominator, exclusions, or exceptions, and used to determine patient eligibility. The accuracy of any measure, and the ability for eligible clinicians to meet data completeness, risk being compromised when ICD-10 codes are updated (October 1). Workflows that are not automatically updated, such as ...
In Audit
May 1st, 2014
Use the latest OIG work plan to amp up your compliance plan and audit efforts. By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO The U.S. Department of Health & Human Services Office of Inspector General (OIG) has released its annual work plan, outlining the new and ongoing hot spots for healthcare fraud and abuse ...
May 1st, 2012
Understand your use of CPT® codes prone to audit review. By Stacy Harper, JD, MHSA, CPC In the current regulatory environment, physicians are searching for ways to minimize audit exposure. Medicare administrative contractors (MACs) frequently review high-level evaluation and management (E/M) services. Review may be based on a random sample, or targeted based on provider ...