The new outpatient CPT® modifier 33 is one of the many changes announced in the latest update to the Outpatient Code Editor Version 12.1, effective April 4, 2011, by the Centers for Medicare & Medicaid Services (CMS), but it’s the most noteworthy. Modifier 33 Preventive services is effective retroactively Jan. 1, 2011, according to CMS Transmittal 2172. [...]
If you’re wondering why your annual wellness visit (AWV) claims aren’t being paid, there’s a good reason. The Centers for Medicare & Medicaid Services (CMS) has instructed all Medicare contractors to hold all AWV claims submitted on types of bill 12X and 13X with dates of service on and after Jan. 1 through April 3. [...]
The General Hospital Corp. and Massachusetts General Physicians Organization, Inc. (Mass General) has agreed to pay the U.S. government $1 million to settle a “potential” violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. As part of the settlement, Mass General also will enter into a Corrective Action Plan (CAP), according to [...]
The Centers for Medicare & Medicaid Services (CMS) has opened separate national coverage analyses (NCAs) for screenings of depression and sexually transmitted infections (STIs), including high-intensity behavioral counseling (HIBC) to prevent STIs. The agency is considering adding these screenings to the list of preventive services already covered by Medicare, such as Pap smear and screening pelvic [...]
Your Medicare patients with pacemakers and defibrillators may be able to have magnetic studies in the very near future, providing data proves supportive. New technology has led the Centers for Medicare & Medicaid Services (CMS) to take another look at its recently updated national coverage determination (NCD) for magnetic resonance imaging (MRI). Section 220.2 of the NCD [...]
Confused whether to code a patient as new or established? Uncertain how to bill chemotherapy infusions for the same patient on the same day? You’re not alone. These are just two of the most common physician billing errors reported by Medicare contractors. To help providers understand these types of claims submission problems and avoid certain [...]
If your practice is having trouble getting ambulance claims paid, perhaps it’s something you said, or didn’t say. In a provider education article, NHIC, Corp., Part B Medicare administrative contractor (MAC) for jurisdiction 14, says the key to getting an ambulance claim paid is to establish medical necessity; and to do that “it is essential [...]
National Government Services (NGS), the jurisdiction B Medicare administrative contractor (JB-MAC), reminds providers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) to submit monthly claims for repetitive services and items in sequence. Failure to do so may mess up reimbursement. This is especially noteworthy if the patient is receiving capped rental equipment such as oxygen or [...]
The Centers for Medicare & Medicaid Services (CMS) released an MLN Matters Special Edition article based on an August 2010 U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) report, “Inappropriate Medicare Payments For Transforaminal Epidural Injection Services.” The purpose of the Special Edition article is “to remind physicians of the importance of properly documenting [...]
The Departments of Health and Human Services (HHS) and the Treasury proposed a new rule, March 10, outlining the steps states can take to receive a State Innovation Waiver under the Patient Protection and Affordable Care Act (Affordable Care Act). The Affordable Care Act gives states the flexibility to receive a State Innovation Waiver beginning in 2017. President Obama [...]
