Tag Archives: center for medicare and medicaid services

CMS Added 11 New Telehealth Services

Effective October 14, 2020, CMS added 11 new services to its list of approved telehealth codes, which include cardiac and pulmonary rehabilitation. This handy list contains all the telehealth services, the dates on which they were approved and whether they … Read Full Post

Tagged center for medicare and medicaid services, cms, telehealth, telehealth codes |

What We’re Reading – CMS Announces the Resumption of Medicare Audits

In a previous post, we announced that CMS would be resuming program integrity audits in August. This recent article explained some additional details of their “short-lived hiatus.” Despite the continuing public health emergency (PHE), CMS did resume on August 3rd … Read Full Post

Tagged center for medicare and medicaid services, cms, payment audits, targeted probe-and-educate (TPE) reviews, telehealth |

CMS Approves COVID-19 Counseling

When patients are tested for COVID and are awaiting results – or if they’ve tested positive – research shows virus transmission is reduced by 86% if these patients self-isolate early. For this reason, CMS recently clarified that counseling, which includes … Read Full Post

Tagged center for medicare and medicaid services, cms, Coronavirus, counseling, COVID-19, E/M |

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

Tagged center for medicare and medicaid services, coding and billing, first coast service options, medicare claim edit, medicare claims, medicare new patient visit, practice management |

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

Tagged Case management, center for medicare and medicaid services, cms, deficiency-free survey, docmentation, home health agencies, home health case managers, medicare beneficiary, quality assurance program, quality of care, RAC recovery-free operation, skilled case manager |

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

Tagged annual wellness visits, center for medicare and medicaid services, chronic kidney disease, cms-hcc model, ffs medicare, government accountability office, health risk appraisals, hierarchical condition categories, medicare advantage enrolles risk scores, medicare advantage plans, medicare payment advisory commission, medicare risk adjustment, mra, national institutes of health, national kidney foundation, risk adjustment in medicare advantage, risk scores, the patient protection and affordable care act |

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

Tagged abn, advanced beneficiary notice of noncoverage, center for medicare and medicaid services, coding & billing, medicare billing, medicare patients, submitting a claim |

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

Tagged bilateral procedure, center for medicare and medicaid services, coding and billing, cpt codes, first coast service options, medicare billing, medicare guidelines, medicare physician fee schedule, modifier 50, modifier lt, modifier rt |

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

Tagged center for medicare and medicaid services, cms manual, coding & billing, extended repayment plan, extended repayment schedule, first coast service options, medicare overpayments, overpayment for medicare claims, recovery audit contractors |

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

Tagged center for medicare and medicaid services, claim denials, claim edits, duplicate claim denials, duplicate claims, medicare claims, modifiers, preventing duplicate claim denials |