NORMAL NEWBORN DRG Code 795

Latest report has a new look and offers insight into the agency’s top targets. Since 2022, the HHS Office of Inspector General (OIG) has issued 30 reports that target Medicare Advantage compliance, nine specifically in the last year. And a [...]

Latest report has a new look and offers insight into the agency’s top targets. Since 2022, the HHS Office of Inspector General (OIG) has issued 30 reports that target Medicare Advantage compliance, nine specifically in the last year. And a [...]

OIG excludes nearly 1,800 from federal programs in period from October through March. A complicated Medicare home health scam is front and center once again, this time in the HHS Office of Inspector General’s new greatest hits report. “To hold [...]

The Senior Medicare Patrol’s recoveries are down, but it’s keeping up the pressure on the hospice industry. Hospices have been feeling scrutiny from regulators for some time, but now it’s coming from a new source — your patients’ peers. “In [...]

In 2020, the Senior Medicare Patrol fraud-fighting program netted about half its $16.8 million in recoveries from a home health investigation (see story, p. 190). For 2021, there’s no mention of home health in the SMP annual report at all, [...]

One ophthalmologist in our sampling would lose $39,000 a year under the new proposal. Although eye care practices have the option of reporting either ophthalmological services codes or E/M codes for their patient encounters, many ophthalmologists and optometrists bill the [...]

Question: Our physician wants to schedule a breast MRI for a Medicare patient who is BRCA2 positive. According to Medicare this service is covered only if it is medically necessary. Can we submit a Medicare claim for this screening MRI? Delaware [...]

Question: Our physician performed a Pap smear and sent it for histopathological examination. The pathology lab however reported inadequate specimen. The physician then repeated the Pap smear on the same patient. How can we report this repeat service? New Mexico Subscriber [...]

Question: In a patient who had an abnormal Pap smear, a cervical biopsy was done. Is there a definitive code for the cervical biopsy? There are however, several diagnosis codes to report the dysplastic changes. Can we submit one of the [...]

Question: In a patient who had an abnormal Pap smear, a cervical biopsy was done. Is there a definitive code for the cervical biopsy? There are however, several diagnosis codes to report the dysplastic changes. Can we submit one of the [...]