Medicare Compliance & Reimbursement

CMS Improves Upon PECOS Enrollment System

Now that the government shutdown is behind us, CMS has started sending out its updates once more, and the latest word is actually a bit of good news.

Providers who have experienced issues accessing the PECOS enrollment system will be glad to hear that CMS updated the software on Oct. 7 to "improve the user experience when registering as an individual practitioner, authorized or delegated official of an organization, or someone working within PECOS on behalf of a provider or supplier (also known as a surrogate)," CMS said in an Oct. 17 announcement.

Thanks to the update, you’ll be able to reset your user ID and password right from your computer, without having to wait on hold for the CMS Help Desk. In addition, designated authorized officials who are already on file with Medicare will be able to get approved access to PECOS quickly without having to submit verification documents to CMS.

CMS will be hosting a free conference call to lead you through the changes on Nov. 15 from 2:00 to 3:15 EST. To register, visit www.eventsvc.com/blhtechnologies.

Modifier 77 Is Your Friend For Diagnostic ER Services

If you forget modifier 77 (Repeat procedure or services by another physician or other qualified health care professional) in the emergency room, it could cost you.

Part B MAC NGS Medicare sent out a reminder on Oct. 10 stating that if practitioners provide a diagnostic service in the ER on the same date as a full service provider performs a service, the claim will be denied unless modifier 77 is appended to it.

You can read more on this topic in the Medicare Claims Processing Manual at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf.

Texas Physician Indicted In $1.4 Million Fraud Scheme

Your physician may be a hard worker, but can you say he works more than 24 hours in a day?

That’s doubtful — and it’s what led to the indictment against a Texas physician who is accused of billing over 4,970 false and fraudulent bills to Medicare and Medicaid totaling over $1.4 million.

The doctor is alleged to have billed for medical services performed on patients who had already passed away. In addition, "he also billed for medical services he claimed to have personally provided to patients in Texas on days when he was overseas or in another state. The indictment alleges that the doctor billed for medical services that would have required him to have personally worked more than 24 hours in a single day."

The doctor was indicted on nine counts of health care fraud, each of which carries a maximum sentence of 10 years in federal prison and a $250,000 fine on conviction.

To read more about the case, visit www.oag.state.tx.us/oagnews/release.php?id=4552.