Medicare Compliance & Reimbursement
At Least 1 MAC Processed Part B Claims Using 21 Percent 'Pricing Error'
21 percent pay cut averted but several claims still slip through the system. President Obama has helped you avert a 21 percent pay cut by signing the "Continuing Extension Act of 2010" -- but one MAC let several claims slip through the system using the discounted payment formula, and the payer is in the process of correcting its error. Just before the president signed the law on April 15, MACs had been holding all claims for dates of service between April 1 and April 14. Even though the pay freeze was retroactive to April 1, some practices worried that their MACs might process claims using the 21 percent reduced fee during the period on April 15 after the claims hold expired but before the president signed the law. In one case, those fears may have been warranted. According to an April 26 notification from Highmark Medicare Services (a Part B payer in five states), several claims for dates of service on or after April 1 and received between April 1 and April 7 "potentially paid at the incorrect -21 percent reduced fee schedule." Highmark indicated that it had "identified the universe of claims impacted by the use of the incorrect fee schedule," and made a mass adjustment. "Our goal is to have initiated 95 percent of all adjustment claims by Wednesday, May 5th," Highmark indicated, promising to provide additional updates as the adjustments are made. (Editor's note: For more on this issue, visit: www.highmarkmedicareservices.com.)
Medicare Compliance & Reimbursement
- Compliance:
Study These Compliance Basics Before You Run Afoul of the OIG
Practice size does not matter when dealing with compliance -- even solo practitioners need to stay [...] - Billing:
Has A Broken Payment Agreement Come To Dismissal?
Take these steps to end a Practice-Patient relationship without creating drama to the parties involved. [...] - Medicare Forms:
CMS: Abbreviate Patient Name "John Doe, Jr." To "John Doe" And You'll Face Denials With New 5010
5010 form could change everything from your claims submission processes to your patient registration systems. [...] - In Other News:
The OIG Has Some Words Of Advice For Practices Billing Claims For $50,000 Or More -- Double Check These Services, Or Subject Yourself To Scrutiny
According to a new audit report entitled "Review of High-Dollar Payments for Outpatient Services Processed [...] - Physician Notes:
At Least 1 MAC Processed Part B Claims Using 21 Percent 'Pricing Error'
21 percent pay cut averted but several claims still slip through the system. President Obama [...] - Part B Coding Coach:
3 Sample Situations Boost Your Migraine Treatment Smarts
Acute episodes, check-ups are both routine for these patients. When migraine headache coding comes up, [...] - Reader Question:
Differentiate Between Debridement and Wound Care Management Codes
Active wound therapy requires different documentation than debridement. Question: When the surgeon performs a wound [...] - Industry News:
Teething Problems: Grandfather Clause In Health Laws Can Result In Raw Deal For Consumers
Definition of "grandfathered" health plans still very vague. Depending on how the Obama administration interprets [...]
