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 […]
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 […]
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. […]
Medicare Awards New Contracts for Recovery Audit Contractors
The Centers for Medicare & Medicaid Services has announced the awarding of the next round of Medicare Fee-for-service recovery audit contractor (RAC) contracts. The Medicare Recovery Audit Program’s mission is to identify and correct improper Medicare medical billing payments through the detection and collection of overpayments made on claims of healthcare services provided to Medicare […]
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 […]
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 […]
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 […]
Free Webinar: Clinical Diagnostic Laboratory Test Payment System
The Centers for Medicare & Medicaid Services (CMS) is hosting a complimentary webinar concerning the clinical laboratory billing. The program, “Clinical Diagnostic Laboratory Test Payment System: Data Reporting Call,” takes place Wednesday, November 2, from 2:30-3:30 pm ET. During this program, attendees will learn how to report data required by the Clinical Diagnostic Test Payment […]