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 […]

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 […]

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 […]