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 […]
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 […]
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 […]
CMS Publishes October 2016 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 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 October 2016 issue include the […]