Tag Archives: center for medicare and medicaid services

What We’re Reading – Medicare E/M claims for new patients

Beginning on October 1, 2013, CMS will use a new claim edit to determine if more than one initial visit code was billed for a Medicare beneficiary within a three year period.   This edit will also identify claims where established … Read Full Post

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Home Health Case Managers Can Save the Day

In the field of home health, the single most important individual just might be the case manager.  Given the increasing pressure for all providers to assure cost-effective, high quality care, a skilled case manager can enhance quality of care and … Read Full Post

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2014 Holds Big Changes for the CMS-HCC Model

The purpose of the CMS-HCC model is to improve the accuracy in predicting the costliness of Medicare Advantage (MA) enrollees’ healthcare costs and to properly fund MA plans for those expenses. It isn’t a perfect model but it surpasses the … Read Full Post

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Is your practice utilizing the Advanced Beneficiary Notice of Noncoverage (ABN) correctly?

The Advanced Beneficiary Notice of Noncoverage, or ABN for short, is a waiver of liability that is provided to all Medicare patients if the provider believes an item/service may not be covered by Medicare or considered medically necessary.  Now that … Read Full Post

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What We’re Reading – Bilateral procedures and MUEs

Are you stumped on when to use modifier 50 instead of modifiers LT and/or RT for Medicare? Modifier 50 is defined as a bilateral procedure which is performed on both sides of the body in the same operative session or … Read Full Post

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What We’re Reading – Manual update regarding the repayment of overpayments

If your business has ever received a demand letter from Medicare regarding overpayments, your first thought has probably been, “How am I going to pay this back while keeping my business afloat?”  There is good news!  Effective September 3, 2013, … Read Full Post

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What We’re Reading – Preventing duplicate claim denials

Are you experiencing more claims denials as duplicates recently?  Make sure that your billing staff and/or billing company are aware that effective July 1, 2013, The Centers for Medicare & Medicaid Services (CMS) instituted new claim edits.  All claims received … Read Full Post

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ICD-10 Implementation is not just Doom and Gloom

Doomsday predictions certainly abound – Heaven’s Gate, Y2K, the Mayan apocalypse – and they all came and went with a fizzle.  ICD-10 has its own group of “end of the healthcare world as we know it” zealots who predict catastrophe … Read Full Post

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Temporary Delay in Implementing Ordering and Referring Denial Edits

Due to technical issues, the implementation of the Phase 2 ordering and referring denial edits is being delayed.  These edits would have checked claims for an approved or validly opted-out physician or non-physician.  If either of these were missing or … Read Full Post

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CMS is holding some provider payments

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release.  For claims with dates of service or “through dates” on or after April 1, 2013, the issues affect … Read Full Post

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