Improper FFS Payments: Coding One Problem Says CMS
The Centers for Medicare & Medicaid Services (CMS) announced last week, in an exhaustive report by two programs monitoring the Medicare Fee-for-Service (FFS) program for errors, that the national error rate is 3.7 percent of the dollars paid, or $10.2 billion. The projected overpayments were $9.3 billion and the underpayments were $0.9 billion.
A product of The Comprehensive Error Rate Testing (CERT) and Hospital Payment Monitoring Programs(HPMP), the study combined error rates calculated by the two programs. According to the study, the largest cause of errors was incorrect coding. Read more in the full 66-page report on the CMS Web site.
Information Collections Up for Public Comment
The Centers for Medicare & Medicaid Services (CMS) published in the Federal Register, Sept. 12, a summary of proposed collection activities and invites public comment. Read more »
ABN Gets a Makeover
Rule Left Out of Medicare Carriers Manual
Imagine being liable for non-covered health care services provided to a Medicare patient. It can happen to you. To safeguard against it, providers, practitioners, suppliers, and laboratories should have Medicare beneficiaries sign an Advance Beneficiary Notice (ABN). It won’t be long, however, before the Centers for Medicare & Medicaid Services (CMS) no longer accepts the ABN forms you’re currently using. Read more »
Since Jan. 1, 2003, physicians have not been required to sign orders for clinical diagnostic tests they felt were medically necessary to provide quality treatment for their Medicare patients. Watch out, though. If a physician doesn’t clearly document his or her intent for the test to be performed in the medical record, the claim could be denied.
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CMS Clarifies Medicare Claims Process
The Centers for Medicare & Medicaid Services (CMS) recently rescinded Transmittal 1557, released July 18, and replaced it with Transmittal 1588, released Sept. 5, to clarify specific business requirements. Read more »
Providers Remain Somewhat Satisfied
The 2008 Medicare Contractor Provider Satisfaction Survey (MCPSS) indicates that Medicare health care providers continue to be moderately satisfied with services provided by Medicare fee-for-service (FFS) contractors.
On a scale of 1 to 6 (6 being completely satisfied), providers say overall contractor performance measures up to a 4.51 satisfaction level, according to the MCPSS survey. In 2007, the average score for overall contractor performance was 4.56, according to a report released by the Centers for Medicare & Medicaid Services (CMS). Carriers and Part B Medicare Administrative Contractors (MACs) received an average score of 4.35—somewhat lower than their counterparts. Read more »
Physicians: No More Signature Stamps!
The Centers for Medicare & Medicaid Services (CMS) has long been concerned about the ease of using signature stamps to defraud the system. As a solution, CMS stopped accepting a physician’s stamped signature on medical records effective Sept. 3, 2007. Read more »
CPAP Business Requirements Updated
If you’ve lost sleep trying to interpret the Continuous Positive Airway Pressure (CPAP) business requirements policy the Centers for Medicare & Medicaid Services (CMS) published July 25 in Transmittal 91, get ready for some well-deserved rest. CMS Transmittal 94, Change Request 6048, released August 29, clarifies wording in the policy. Read more »
New Needle for Oocyte Collection on the Horizon
Women who suffer from infertility and are considering in vitro fertilization (IVF) might want to hop on a plane to Europe for treatments. Currently, that’s the only place physicians are able to use an innovative oocyte collection needle that is said to minimize tissue damage, bleeding, and pain often associated with the procedure.
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New Tool to Ablate Soft Tissue
Surgical oncologists, interventional radiologists, hepatobiliary surgeons and other medical specialists have a new tool they can use to ablate soft tissue-and it’s reportedly fast and efficient. Read more »
Study Questions Need for Extra Tissue Sampling
Just how much tissue sampling is required when unsuspected minimal prostate carcinoma is identified on transurethral resection of the prostate (TURP)? A recent study asks that question. Read more »
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