Tag: Medicare Claims

Telehealth Billing Rules

CMS: Pay Attention to Telehealth Billing Rules

  CMS recommends that organizations review the agency’s most recent guidance on telehealth billing. CMS is reminding providers to ensure that Medicare claims for telehealth are correctly billed. The agency issued broadly expanded telehealth services as part of its response to the COVID-19 public health emergency. However, a 2018 Office of Inspector General audit found that CMS […]
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April 2021 HCPCS Codes Changes

April Updates Bring HCPCS Changes

Make sure you’re using the latest code files for your Medicare claims. A second quarter update to the HCPCS Level II code set used for reporting products, supplies, and services adds 23 codes. Additionally, six codes are revised and 12 are discontinued, effective April 1, 2021. There are also two codes with changes to Medicare coverage. […]
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medical necessity errors

Top Error Rates Offer Clues to Denials

The Comprehensive Error Rate Testing (CERT) program grew out of the Department of Health and Human Services Office of Inspector General improper payment rate estimates from 1996 through 2002. Due to sample size restrictions, the Centers for Medicare & Medicaid Services (CMS) assumed responsibility because they had access to more granulated data in 2003. The […]
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2021 MIPS Updates

Final Rule Updates MIPS for 2021 and Beyond

  CMS continues to phase in the Quality Payment Program while MACRA mandates loom. The long-awaited Physician Fee Schedule (PFS) final rule, now pending publication in the Federal Register, finalizes proposed updates to the Quality Payment Program (QPP) and its two tracks — the Merit-Based Incentive Payment System (MIPS) and Advanced Alternate Payment Models (APMs) — for performance […]
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