DECISION SUPPORT SYSTEMS: Medicare Imaging Demonstration Project to Study
July 2011
In case you haven't yet heard, the Centers for Medicare & Medicaid Services (CMS) will launch a Medicare imaging demonstration (MID) project in July to study appropriate utilization of advanced imaging services. The demonstration includes only those services provided to Medicare fee-for-service beneficiaries paid under Part B (hospitals and outpatient clinics). Inpatient (Part A) and emergency department imaging services are excluded.
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Place of Service Codes: Get Them Right to Ensure Compliance
April 2011
One of the projects included in the Department of Human Services' Office of Inspector General's (OIG) 2011 work plan is a review of claims for proper place-of-service (POS) coding for physician services. These two-digit POS codes are placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry.
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OIG Issues 2011 Work Plan: Several Radiology-Related Audits Planned
February 2011
Each year about this time, the Department of Health and Human Services' Office of Inspector General (OIG) launches its general work plan for the next calendar year. For 2011, the OIG has seven audits (called "areas of investigation" in the report) scheduled for providers who deliver radiology services to Medicare Parts A and B beneficiaries. Of the projects announced, three of these are "new starts" and four are what the OIG calls "works in progress." In other words, if you're aware of the OIG's work plans from previous years, the works in progress below will sound familiar.
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When using a thrombectomy catheter during percutaneous cardiac intervention (PCI), can 92973 be assigned when a manual extraction catheter such as the Pronto or Quick-Cat is used?
November 2010
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Financial Impact of Lab Audit Findings: Dig Deep to Uncover Reasons for Claim Denials
November 2010
In the course of performing a laboratory billing audit, I observed that a charge for an alkaline phosphatase (CPT 84075) sometimes appeared on the same claim with a charge for a comprehensive metabolic panel, CPT 80053. Given that the alkaline phosphatase (alk phos) is one of the components of the comprehensive metabolic panel (CMP), the facility received a line item rejection of the alk phos and no additional money for the procedure. This finding raised several questions that begged asking.
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Anti-Markup Payment Limitations: CMS Issues Instructions for Policy Compliance
May 2010
In two recent transmittals, the Centers for Medicare and Medicaid Services (CMS) advise physicians and other suppliers who bill for diagnostic tests (excluding clinical diagnostic laboratory tests) to understand when the anti-markup limitation applies and when it doesn't.
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Under the RAC Microscope: Medical Necessity of Services
March 2010
When it comes to recovery audit contractors (RACs), hospital leaders continue to ask: Where should we focus our time and attention? The answer is medical necessity-a key RAC target.
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Proposed 2010 Hospital OPPS Rule Issued: Many Changes Included, Some Welcomed
November 2009
As you may know by now, the Centers for Medicare & Medicaid Services (CMS) have issued the proposed rules for 2010. One of the rules contains updated payment policy and rates for the hospital outpatient prospective payment system (OPPS) as well as ambulatory surgical centers (ASCs). The other rule updates the Medicare physician fee schedule (MPFS). Whatever elements of the proposed rules become final will take effect on January 1, 2010.
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New ICD-10-CM Coding System: CMS Sets Date for Implementation
July 2009
Just six months after it issued a proposed rule for adopting the ICD-10-CM code sets, the U.S. Department of Health and Human Services (HHS) issued two final rules related to the topic. This is surely record time for the agency, indicating that its leaders are definitely listening to the likes of industry associations such as the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA).
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2009 Coverage for Telehealth Technology: More Reimbursable Services and Eligible Sites
May 2009
Radiology is among the medical specialties that most frequently use telehealth technology. The 2009 Medicare physician fee schedule (MPFS) adopts a couple of provisions of interest to those radiology practices now offering, or may offer in the offer, these services.
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BE PREPARED FOR MAC TRANSITION: Tips to Minimize Billing Disruption
March 2009
By now, you've heard of Medicare administrative contractors (MACs)-firms that are taking over the responsibility of Medicare claims processing from fiscal intermediaries (FIs) and carriers. The Centers for Medicare & Medicaid Services (CMS) has already awarded MAC contracts to 10 of the country's 15 jurisdictions, and providers in many of these jurisdictions have claims systems up and running with their new MACs. For those providers who have yet to participate in the MAC program, the CMS recently issued instructions to help smooth the transition.
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More Bundled Medicare Payments Ahead: ACE Demonstration Tests Concept for Acute Care
September 2008
With the recent announcement of the Acute Care Episode (ACE) Demonstration, the Centers for Medicare & Medicaid Services (CMS) sent a signal to the industry that it intends to head in the direction of bundled payments for inpatient physician and hospital services, at least for select procedures. The ACE Demonstration will test whether the new payment structure results in cost efficiencies and quality improvements for Medicare and its beneficiaries.
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Physician Signatures on Test Requisitions: CMS Clarifies Medicare Policy
July 2008
Has your laboratory received documentation requests from the comprehensive error rate testing (CERT) contractor (AdvanceMed) asking for an original requisition signed by the ordering physician? If so, you're not alone. According to a letter from the American Clinical Laboratory Association (ACLA) to the Centers for Medicare & Medicaid Services (CMS) in mid-March, many laboratories have received such requests. What's more they received notification that the testing is inappropriate, and the claim will be denied if no such requisition can be produced. (Don't panic! It's not true.)
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