Part B Insider (Multispecialty) Coding Alert
PSC Background
The Health Insurance Portability and Accountability Act of 1996 created the Medicare Integrity Program to reduce fraud and abuse in Medicare and gave CMS the authority to contract with entities to battle fraud. The new contractors, called Program Safeguard Contractors, work with the Part B carriers. They do things like medical review, data analysis, provider education and fraud detection.
CMS has named 12 PSCs with national and local responsibilities. Several of them also operate as Part B carriers, including Cahaba GBA, Mutual of Omaha, and Tricenturion, a joint venture that includes Palmetto GBA and Trailblazer Health Enterprises. According to the Regence of Utah Web site, at least one PSC, Computer Sciences Corp., only started its work as recently as July 2003. "Using the PSCs to creatively partner with traditional Medicare contractors is a win-win situation for all involved," Regence states.
In the case of Utah, Regence says it's working closely with CSC to avoid disruptions to providers as CSC takes on some of the fraud-fighting functions. It's up to CMS to make sure the two contractors coordinate properly, Regence adds. CMS has required both parties to enter into a Joint Operating Agreement delineating each party's roles and responsibilities.
Part B Insider (Multispecialty) Coding Alert
- Cardiac Stress Testing:
Boost the Patient's Heart Rate Without Giving Yourself a Heart Attack
Carrier cracks down on Adenosine claims with poor documentation
If you're not putting heart patients [...] - Coding Descriptors:
Changes Make It Easier to Bill for Multiple Bronchoscopy Sites
The 2004 CPT book updates the descriptors for several bronchoscopy codes, and the change may [...] - ICD-9 Codes improve Adenosine Billing
Luckily, this year's ICD-9 code updates actually made it easier to choose a diagnosis code [...] - Fraud and Abuse:
Program Safeguard Contractors Create Havoc for Physicians
Now an extra hand stirs the pot, but are the watchdogs talking to each other?
If [...] - Coverage:
CMS Announces TEB Decision
In Transmittal 6, issued Jan. 23, the Centers for Medicare & Medicaid Services announced it's [...] - Part B Coding Coach:
4 Steps Reduce Denials for Teaching Physician Services
Use these tips to clarify confusing Medicare guidelines
You can ensure that [...] - Debridement:
Don't Confuse 97601 and the 11040-11044 Series, Carrier Says
One is an NPP code, the other requires more certification
Getting to [...] - PSC Background
The Health Insurance Portability and Accountability Act of 1996 created the Medicare Integrity Program to [...] - Newsbites:
Carrier Considers Easing the Way for Overnight Pulse Oximetry Studies
Carriers clarify genetic testing, post-op epidural policies
If you're confused about how [...] - Physician Notes:
LA Dodgers Team Physicians Hit With False-Claims Act Settlement
If you find compliance problems through internal audits, you'd better take action on them if [...]
