In Billing
Feb 19th, 2018
Effective Jan. 1, 2018, newly approved biosimilar biologicals with a common reference product are no longer grouped into the same billing code. This change was finalized in the 2018 Medicare Physician Fee Schedule final rule. Q5102 Replaced with Two New Codes The April 2018 update to the Medicare Physician Fee Schedule Database (MPFSD) includes three ...
In Billing
Feb 14th, 2018
The HCPCS Level II code G0475 HIV antigen/antibody, combination assay, screening is effective for dates of service on or after April 13, 2015, and is subject to Clinical Laboratory Improvement Amendments (CLIA) edits, despite its omission in previous transmittals from the Centers for Medicare & Medicaid Services (CMS). For Medicare reimbursement, G0475 requires a facility to have either a ...
In Billing
Jan 29th, 2018
Continuing the effort to prevent and combat healthcare fraud, waste, and abuse where it occurs most, the Centers for Medicare & Medicaid Services (CMS) has extended the statewide temporary moratoria on the enrollment of new Medicare Part B, Medicaid, and Children’s Health Insurance Program (CHIP) non-emergency ground ambulance providers and suppliers and home health agencies, sub-units, and ...
In Audit
Jan 26th, 2018
The Centers for Medicare & Medicaid Services (CMS) measures the fee-for-service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. According to a 2017 CERT report, CMS had a 90.5 percent proper payment rate and a 9.5 percent improper payment rate for all claims submitted July 1, 2015, to June 30, 2016. ...
In Billing
Jan 12th, 2018
Your practitioners may be performing services for which they are neither being reimbursed nor receiving credit toward their quality reporting. You can help maximize their earning potential and receive credit where it’s due by pointing out these three separately payable services. Chronic Care Management Chronic conditions (e.g., Alzheimer’s disease, arthritis, asthma, cancer, depression, HIV, strok...