Medicare Compliance & Reimbursement
CMS Overhauls Medicare Advantage Program
Oversight of MA could tighten significantly. CMS announced on March 30 that it will make significant changes to Medicare Advantage. For instance,CMS will require MA organizations to ensure that all of the plans they offer in 2010 are significantly different from one another so beneficiaries can make better enrollment decisions. With fewer MA plan options on the market, CMS will be able to eliminate the low-volume plans that "crowd the market," according to a March 30 CMS press release on the topic. CMS notes that 27 percent of total MA plans that have fewer than 10 enrollees. "Having more transparent information available to help people with Medicare make confident choices in their health and drug coverage is important to President Obama and CMS," said Jonathan Blum, acting director of CMS's Center for Drug and Health Plan Choice. "By strengthening our oversight efforts, we are protecting beneficiaries and taxpayers by ensuring that the data provided by plan sponsors is reliable and correct." Plus: CMS also intends to review MA cost-sharing to ensure that sicker patients will not face inflated out-of-pocket charges for services such as renal dialysis, Part B drugs, or skilled nursing, according to the March 30 press release. Keep in mind: CMS intends to tighten its oversight of MA by stepping up audits of these services, CMS said. "Auditors are going to be watching the MA programs more closely, so perhaps complaints (especially when documentation shows that the beneficiary was harmed or lied to) may get further, says Barbara J. Cobuzzi, MBA,CPC,CPC-H, CPC-P, CENTC, CHCC, senior coder and auditor for The Coding Network, and president of CRN Healthcare Solutions. To read more of CMS' recommendations, visit www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/2010CallLetter.pdf.
Medicare Compliance & Reimbursement
- RED FLAGS RULE:
No Red Flags Program? You Could Be Losing Thousands
Tip: Institute your Red Flags program ASAP. You may think the government is implementing the [...] - MEDICARE ADVANTAGE :
CMS Overhauls Medicare Advantage Program
Oversight of MA could tighten significantly. CMS is buckling down on the Medicare Advantage (MA) [...] - RED FLAGS RULE :
Act Quickly If Your Practice Identifies a Red Flag
Identity theft is nearly a $50 billion industry. You've implemented a Red Flags program at [...] - BILLING :
Make Sure You Charge For All Your Services
Measure charges and take action, experts say. So you've got a handle on your accounts [...] - DIAGNOSIS CODING :
CMS Dismisses Attachment D Concerns
Sequencing, risk adjustment not harmed by new guidance on secondary diagnosis coding, CMS official maintains. [...] - PART B REVENUE BOOST :
Brush Up on Your ICD-9 Know-How With These 3 Tips
Confused about fifth digits or V codes? Look no further. Insurers base your reimbursement on [...] - CODING COACH :
Keep Chronic Pain Denials at Bay With Surefire Diagnosis Tips
Be careful not to put words in your physician's mouth, or risk audit woes. Imagine [...] - INDUSTRY NOTES :
Nevada Radiology Group Gets $2 Million Fine
Plus: One RAC reveals information about how it will evaluate claims during its review process. [...] - IN OTHER NEWS ...• If your head is spinning with all of the changes between PQRI and e-prescribing, CMS has just the tool for you.
New MLN Matters article MM6394, dated March 20, offers a full breakdown of who is [...]
