CMS has addressed more than a dozen of the most frequently asked questions about Medicare coverage of chiropractic services over the years. These questions — and the responses provided by CMS, edited for readability — are as follows: Q: Are there any visit caps or limits for chiropractic services? A: No. There are no caps/limits […]
Insufficient Documentation Triggering Improper Payments for Laparoscopic Hernia Repair
Insufficient documentation has long been understood as a cause of many improper payments for laparoscopic hernia repairs. This was validated a while back when a Comprehensive Error Rate Testing (CERT) contractor conducted a special study of medical billing claims for laparoscopic hernia repairs. When CERT reviews a claim, all lines submitted on the claim undergo […]
Medicare Provides Guidance on Billing for Implantable Automatic Defibrillators
At one time, Centers for Medicare & Medicaid Services (CMS) found that approximately 85% of improper payments relating to the billing of implantable automatic defibrillators were due to insufficient documentation. The figure was determined through a Comprehensive Error Rate Testing (CERT) program’s special study of Healthcare Common Procedure Coding System (HCPCS) code 33249 (Insertion or […]
December Blog – Changes Coming to Medicare in 2021
There are several changes coming to Medicare benefits for 2021: Every year, a cost-of-living adjustment (COLA) is announced. In 2020, benefits increased by 1.6% and for 2021, benefits will increase by 1.3%. This will result in an average increase of about $20 per month. The Medicare cost increases for 2021 are as follows The standard […]
Gastroenterology Billing Compliance: Enteral Infusion Pumps
The Centers for Medicare & Medicaid Services (CMS) has released a video that contains guidance to help providers bill correctly for enteral infusion pumps. Medicare Part B covers enteral nutrition supplies and equipment (feeding pump) under the prosthetic device benefit. The two-minute video discusses Medicare coverage criteria for enteral infusion pumps and the four pieces […]
Medicare Releases 2017 Ambulatory Surgery Center Payment Final Rule
The Centers for Medicare & Medicaid Services recently released its 2017 ambulatory surgery center (ASC) payment final rule. There were a few changes worth noting, according to the national ASC Association (ASCA). 1. Payment increase. ASC payment rates will increase by 1.9%, which is larger than the 1.2% identified in the proposed rule. 2. Procedures […]
CMS Releases Laboratory Billing Compliance Fact Sheet
The Centers for Medicare & Medicaid Services (CMS) has released a new provider compliance fact sheet concerning laboratory medical billing. The fact sheet noted that a HHS report revealed “laboratory tests – other” (e.g., urine drug screening, medication assays, genetic tests, tissues examination, blood tests) had an improper payment rate of 39 percent, with a […]
CMS Issues Reminder About Reporting Medicare Enrollment Changes
The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to Medicare-enrolled providers concerning reporting changes in enrollment information. Failure to comply with the requirements to report changes in Medicare enrollment information could result in the revocation of Medicare billing privileges. All physicians, non-physician practitioners (e.g., physician assistants, nurse practitioners, clinical nurse specialists, […]
OIG Report: $76 Million in Questionable Medicare Payments for Chiropractic Services
The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recently analyzed Medicare paid claims for chiropractic services from 2013. A major finding: In 2013, $76 million in Medicare payments for chiropractic services were questionable, with Medicare inappropriately paying $21 million for chiropractic services that lacked a primary diagnosis covered […]
Register for Tomorrow’s Clinical Diagnostic Laboratory Test Payment System National Provider Call
The Centers for Medicare & Medicaid Services (CMS) is hosting a free MLN Connects National Provider Call that will discuss the Clinical Diagnostic Laboratory Test Payment System proposed rule on November 10 from 2:00-3:00 p.m. Eastern. The proposed rule — CMS-1621-P — would significantly revise the Medicare payment system for clinical diagnostic laboratory tests and […]