Mar 06, 2020
 | 
The Bottom Line

The Centers for Medicare & Medicaid Services (CMS) has created a series of fact sheets explaining the basics of HIPAA Administrative Simplification transactions and code sets. These fact sheets are designed to help the healthcare industry understand the purpose of HIPAA adopted transactions (ncluding billing) and to explain which standards and operating rules govern each transaction

Mar 06, 2020
 | 
The Bottom Line

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well. For further COVID payment guidance, view CMS' fact sheet.

Mar 06, 2020
 | 
The Bottom Line

In a recent report, the Office of Inspector General (OIG) determined that Medicare made Part B payments to ambulance suppliers for transportation services that were also included in Medicare Part A payments to Skilled Nursing Facilities, as part of consolidated billing requirements. CMS developed the Ambulance Fee Schedule and Medicare Transports (PDF) Booklet to help you bill correctly

Feb 27, 2020
 | 
The Bottom Line

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. CMS states it will correct this issue in October.

Feb 21, 2020
 | 
Billing Alert for Long-Term Care

If every “i” is not dotted and every “t” not crossed when submitting a claim, an overpayment may result, even if services rendered to the patient were medically necessary. The appeals process is designed to give providers a chance to explain their case. It’s also a mechanism to make sure the audit was conducted properly. The following tips may not help you win every appeal, but they certainly won’t hurt your case.

Feb 07, 2020
 | 
The Bottom Line

On February 5, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit (Part D) program to give seniors more choices and lower out-of-pocket costs, and to encourage price transparency. The proposed rule is another step in lowering drug costs for seniors, increasing competition, and further advancing the agency’s efforts to strengthen and modernize the popular MA and Part D programs.

Jan 31, 2020
 | 
The Bottom Line

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020. The rule includes an 8% cut from Medicare payments for physical and occupational therapy services starting in 2021.

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