When laboratory services are billed by providers other than the end-stage renal disease (ESRD) facility and the laboratory service furnished is designated as a service that is included in the ESRD Prospective Payment System (PPS), Medicare will reject or deny the claim. This is according to recent issue of Medicare Quarterly Provider Compliance Newsletter, a […]
Medicare Provides Guidance on Facet Joint Injection Billing
Medicare has found that insufficient documentation is a common cause for improper payments for facet joint injection procedures. This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter, a newsletter from CMS developed to help providers to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. The […]
CMS Publishes January 2017 Medical Billing Errors Newsletter
The Centers for Medicare & Medicaid Services has published its latest Medicare Quarterly Provider Compliance Newsletter, which provides guidance to address medical billing process errors. The newsletter is designed to identify common billing errors and other erroneous activities when dealing with the Medicare Fee-For-Service (FFS) Program. Topics discussed in the January 2017 issue include the […]
Rhode Island Working to Address Surprise Medical Billing
Rhode Island has become the latest state to take steps in an effort to address the ongoing challenge of surprise bills for medical services. As the Providence Journal reports, state lawmakers are sponsoring legislation that would provide for a dispute resolution process for emergency services and surprise bills for medical services performed by nonparticipating (i.e., […]
CMS Increases Definitive Drug Testing Reimbursement
The Centers for Medicare & Medicaid Services (CMS) will increase reimbursement for toxicology drug confirmation codes in 2017. Background For 2016, CMS implemented four new HCPCS G codes for definitive drug testing: G0480 G0481 G0482 G0483 CMS priced these codes using a crosswalking fo rmula. The first two tests performed were paid at the full […]
Keep Out of Hot Water: Watch This False Claims Act Compliance Video
The Centers of Medicare & Medicaid Services (CMS) is reminding healthcare organizations about the importance of complying with the False Claims Act. False claims are not claims with innocent billing mistakes. Rather, providers know these claims are false. They include services that are: Not rendered Upcoded Not supported by the patien’’s medical record Part of […]
CMS Updates ESRD Prospective Payment System
The Centers for Medicare & Medicaid Services has issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2017. The rule also finalizes new quality measures for dialysis facilities treating patients with ESRD. […]
Chiropractic Billing in the Regulatory Spotlight
The Office of Inspector General (OIG) recently released a 2016 final report on Medicare payments for chiropractic services. In its review, OIG included chiropractic services for CY 2013 for which Medicare Part B paid approximately $438 million. On the basis of its sample results, OIG estimated that approximately $359 million, or approximately 82 percent, of […]
Laboratory Medical Billing Compliance Fact Sheet for Urine Drug Screening
The Centers for Medicare & Medicaid Services (CMS) has released a new provider compliance fact sheet concerning laboratory billing. More specifically, the fact sheet concerns requisitions or orders for urine drug screening laboratory tests. The fact sheet noted that a HHS report revealed “laboratory tests – other,” which includes drug screenings, had an improper payment […]
Medical Billing Outsourcing on the Rise: 5 Contributing Factors
A new report by Grand View Research examines the growth of medical billing outsourcing. Grand View projects the outsourcing market to grow by more than 150% from 2015 to 2024. Here are five of the factors that will contribute to the significant growth, according to Grand View: Current systems in practice for managing revenue are […]