Posts Tagged ‘Centers for Medicare & Medicaid Services’
CMS issues new condition code for home health claims
The Centers for Medicare and Medicaid Services (CMS) has added a new condition code that will allow home health claims for subsequent episodes to process, even if skilled nursing services are not required. The change takes effect July. 1 Currently, any home health claim that is submitted without skilled nursing visits are automatically returned to…
Read MoreCMS clarifies 60-day overpayment rule
The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule that details the reporting and returning of Medicare Part A and B overpayments. The proposed rule left providers asking many questions. The final rule provides needed clarity and consistency in the reporting and returning of self-identified overpayments. It is designed to…
Read MoreHow data mining is uncovering healthcare fraud
What does your data say about your healthcare practice? Does it show that you bill considerably more than your colleagues for certain types of procedures? What about your facility? Is it performing more of a particular procedure than nearby competitors? These days, healthcare fraud investigators increasingly rely on data to root out healthcare fraud. They…
Read MoreFinalized DME rule targets fraud, abuse
The Centers for Medicare and Medicaid Services has finalized a rule that creates a prior authorization process for some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that it has determined are often subject to unnecessary utilization – i.e. healthcare fraud. The rule was first proposed in May 2014 and included a Master List of…
Read MoreICD-10: How is your practice handling the transition?
It’s been a few weeks since the launch of ICD-10 and there have been a number of stories written about some of the challenges that healthcare providers are facing and how the new billing codes are having an impact on their practices and patient care. Although still early in its implementation, it appears those who…
Read MoreOMHA to expand Medicare appeals process
Faced with skyrocketing processing times, the Office of Medicare Hearings and Appeals (OMHA) says it plans to expand its Settlement Conference Facilitation pilot project in an effort to clear through the ever-growing backlog of claims appeals. The pilot project, which began in June 2014, is an alternative dispute resolution process. It was created to bring…
Read MoreBundled payments: What impact will they have on your practice?
In an effort to shift payment models away from fee-for-service, more healthcare providers are being paid based on their ability to provide high-quality care in a more coordinated fashion through bundled payment arrangements. To that end, The Centers for Medicare & Medicaid Services (CMS) recently announced that more than 2,100 acute care hospitals, skilled nursing…
Read MoreCMS’ fraud crackdown relies on high-tech analytics
The government’s crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments. Aptly named the “Fraud Prevention System,†the program has identified or prevented $820 million…
Read MoreCMS to cut providers a break when it comes to ICD-10 deadline
With the implementation of ICD-10 just around the corner (Oct. 1) comes word from the Centers for Medicare & Medicaid Services that it will not deny claims made under the Part B physician fee schedule if there are coding errors. The guidance notice, which was issued with the blessing of the American Medical Association, is…
Read MoreCMS releases final rule for Medicare Shared Savings Program ACOs
The Centers for Medicare & Medicaid (CMS) earlier this month released its much- anticipated Final Rule updating the Medicare Shared Savings Program. The whole concept behind the program, created by the Affordable Care Act (ACA), is to encourage participation among providers through the use of accountable care organizations (ACOs). ACOs are groups of providers that…
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