The below articles are all published in BC advantage
Magazine and written and contributed by Darren
Carter, MD
Darren Carter, MD
at
Comprehensive Error Rate Testing (CERT) Focus on CPT 99211
Annually, the Centers for Medicare and Medicaid Services monitor the accuracy of Fee-For-Service (FFS) payments. CMS contractors use the Comprehensive Error Rate Testing (CERT) program to determine which services are experiencing high error rates. On...
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Preparing for an FI/Carrier to MAC Transition
Central to the contracting reform plan in the Medicare Modernization Act of 2003 was to obtain competitively procured contracts that conform to the Federal Acquisition Regulation (FAR). Fifteen new Medicare Administrative Contractors (MACs), processi...
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Medicare Moves Forward with Phase III for Fraud Edit Module
In April 2009, the Centers for Medicare & Medicaid Services (CMS) will implement a Fraud Edit Module that will allow claims payment and program safeguard contractors to create on-the-fly edits to immediate address fraud on a national level while leve...
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ICD-9-CM 2009 Changes
This year's ICD-9-CM updates are numerous and broad reaching. Here are the stats:
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Medicare Physician Fee Changes in 2008
Physician should be aware of some changes to the Medicare Physician Fee Schedule, which pays for over 7000 physician services performed for Medicare beneficiares across all places of services.
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Coding Diagnoses in Patients Treated Successfully for Malignancy
The ultimate goal of cancer therapy to complete remove or eradicate a malignant tumor. Patients who no longer have signs of a malignancy may still require ongoing maintenance therapies related to the cancer or may need future care unrelated to the ca...
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Dr. Carter's Corner : CPT Updates for 2008
Let's take a look at the CPT changes for 2008 recently published by the AMA. For 2008, 51 codes were deleted across all major code groupings. 306 code descriptions were updated. There are 242 new codes. The following are temporary codes:
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Testing Your NPI on Medicare Claims Submitted to Carriers and MACs
Unlike some health plans, there is no fax number, phone number or special website you need to use to communicate your NPI to Medicare, except including your NPI on your Medicare claims. To date, Medicare has encouraged providers to submit both an NPI...
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Nine-Digit ZIP Codes Required for Some MPFS and Anesthesia Service Payments
Medicare carriers and Fiscal Intermediaries (FIs) use the ZIP code on the claim where the service was performed to determine the payment locality for services paid under the Medicare Physician Fee Schedule (MPFS) and anesthesia services.
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The New UB-04 and Present-on-Admission Indicator
Almost concurrent with the update to the CMS-1500 form, facility providers will be implementing a new paper form. Beginning March 1, 2007 providers can start to use the new UB-04 form, which is replacing the UB-92 form. By May 23, 2007, it will be th...
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Part D Coverage Determinations
In order for physicians to avoid coverage clarification calls for drugs prescribed to Medicare beneficiaries, they should learn the differences in coverage rules in Part B and Part D for the medications that they routinely prescribe. Part B covers a ...
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