Everything's up-to-date in Kansas City
Last week, I received a call from a doctor's office inquiring why her claim for a B-12 injection might have been denied by a particular payer. She indicated that they used Current Procedural...
View ArticleMedicare shoots first and asks questions later
On Oct. 5, 2009, the Centers for Medicare and Medicaid Services (CMS) quietly began implementing system edits intended to assure that Medicare Part B providers and suppliers bill for ordered or...
View ArticleCMS issues a temporary cease fire
As a follow-up to my last posting ("Medicare shoots first and asks questions later," Nov. 19), I wanted to let readers know that the Centers for Medicare and Medicaid Services (CMS) announced on Nov....
View ArticleCMS extends cease fire on referring/ordering edits
This posting is in follow-up to "CMS issues a temporary cease fire," a posting from last December. I am happy to announce that the Centers for Medicare and Medicaid Services (CMS) has extended the...
View Article2010 Medicare physician fee schedule: Stop me if you've heard this one before
I know that it's April 1, but this is not a joke. The U.S. Senate dropped the ball again, and Medicare payment allowances for physicians dropped 21 percent today. As you will recall from my last post...
View ArticleAnd so it begins ... Medicare claims pay out today, fees cut 21 percent
With half of the year behind us, the Medicare Physician Fee Schedule for 2010 still hangs in limbo. This afternoon, the Senate voted to delay the cut another six months, but the cut is still in place...
View ArticleNew time limit for filing Medicare claims
Historically, as authorized by statute and the Centers for Medicare and Medicaid Services (CMS), physicians had a minimum time limit for filing Part B claims of 15 months and a potential maximum of 27...
View ArticleCMS offers free ICD-10 teleconference on Sept. 13
The AAFP has information and resources for learning about and planning for transition to HIPAA 5010 electronic transaction standards and ICD-10 diagnosis codes, but we thought it might also be helpful...
View ArticleShields and swords
What is the difference between a shield and a sword? Sometimes, it's hard to tell and may depend on where you sit. This point was driven home to me recently in an exchange of correspondence between...
View ArticleMedicare to deny claims with no NPI
The day of reckoning is finally coming for those who order or refer items or services for their Medicare patients but who lack the proper identification.On May 1, the Centers for Medicare &...
View ArticleMedicare delays penalties for claims with invalid or missing NPIs
In a recent post, I referenced that the day of reckoning was finally coming for those who order or refer items or services for their Medicare patients but who lack the proper identification. As it...
View ArticleChanges coming to Medicare payments for durable medical equipment
If you prescribe durable medical equipment (DME) for your Medicare patients, you should be aware that, effective July 1, Medicare will expand its competitive bidding program for DME, prosthetics,...
View ArticleMedicare offers some relief on transitional care management claims
Another month, another set of Medicare fixes aimed at helping physicians submit and receive reimbursement for transitional care management (TCM) claims. During an Aug. 27 conference call with...
View ArticleMedicare clarifies coverage for incarcerated beneficiaries, issues refunds
Medicare is cleaning up the mess it made last summer when it denied claims and initiated recovery of previously paid claims based on faulty data from the Social Security Administration about supposedly...
View ArticleSGR delay puts brakes on Medicare physician fee schedule claims
While physicians wait to see if Congress passes legislation today that avoids a 24 percent cut to Medicare payments, the continuing debate over the Sustainable Growth Rate (SGR) is already affecting...
View ArticleMedicare releases physician claims data for public consumption
Last week, the Centers for Medicare & Medicaid Services (CMS) released on its website a data set detailing payments made in 2012 to more than 880,000 physicians from the Medicare Part B...
View ArticleDealing with the opportunities and threats of the new Medicare data release
This month's release by the Centers for Medicare & Medicaid Services (CMS) of a public use file on Medicare physician utilization and payment data creates both opportunities and threats for family...
View ArticleMedicare gives update on claim denials for incarcerated beneficiaries
Last year, the Centers for Medicare & Medicaid Services (CMS) refused to reimburse or ordered repayments from medical practices that had provided health services to beneficiaries the agency’s...
View ArticleMedicare Part D policy changes could confuse patients
With the end of the year rapidly approaching, Medicare prescription drug plans are notifying their enrollees of changes for 2015. If an example shared with me by one family physician is any...
View ArticleOIG to focus on place of service coding by physicians
As part of its Fiscal Year 2015 work plan (which began Oct. 1), the Health and Human Services Office of Inspector General (OIG) says it will examine place of service coding errors by physicians....
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