Insufficient documentation is the leading cause of improper payments for claims involving referring providers, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the October 2015 Medicare Quarterly Compliance Newsletter .
CMS released a new resource to help providers find the right contacts for ICD-10 questions involving Medicare and Medicaid claims. The resource guide and contact list provides phone numbers or email addresses for Medicare Administrative Contractors and state Medicaid offices for each state and U.S. territory.
Recovery Auditors have identified numerous potential duplicate claims from Medicare Part B providers, according to the October 2015 Medicare Quarterly Compliance Newsletter . These claims are send to MACs for further action, which could include overpayment recovery.
In the first three years after implementation, incentives and penalties tied to the Hospital Value-Based Purchasing (HVBP) Program had a minimal effect on Medicare, while doing little to improve quality trends, according to a recent Government Accountability Office (GAO) report.
Sometimes people do their homework with setting up a new system, and sometimes they don't. Sometimes they do their homework, but not enough of it, and billions of dollars of wasteful spending occurs that could be avoided. But "they" won't listen.
Because CMS has not created any national ED E/M guidelines, providers must create their own criteria for each visit level. CMS has developed a list of 11 criteria that it uses when auditing facility E/M criteria.
Providers have to create their own ED E/M guidelines, which can present a variety of challenges for facilities. For coders, this means an understanding of how to calculate critical care and other factors in order to report the correct visit level.
Providers need to report all services from October 1 forward with ICD-10 codes, but many will likely face scenarios with patients whose dates of service begin prior to October 1 and end after implementation. CMS has released special guidance to clarify how those instances would be billed with each bill type in MLN Matters ® SE1325 .
Sue Bowman, MJ, RHIA, CCS, FAHIMA, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, provide strategies for coders and coding department managers to speak with physicians regarding ICD-10 in order to allay physicians’ fears.
