2015 Context Physician Fee Reports - Now Available at Amazon.com!

  • Kate Armbruster
  • Jan 12, 2015
  • Comments

         The challenge facing physicians Which fees are too high or too low? What can I charge for new procedural c odes? What does Medicare allow? What data can help me with managed care negotiations or payer network contracting?   The solution Resolve these issues with Context Physician Fee Reports. These customized benchmarking tools contain the current Medicare Fee Schedule and usual, customary, a ...

CMS Announcement - Holding of 2015 Date-of-Service Claims - MPFS

  • Margaret Klasa DC, APN BC
  • Dec 30, 2014
  • Comments

While the Compliance Edge blog is typically reserved for original content authored by Margaret Klasa, DC, APN, Bc, at times, we will re-post industry news or announcements that are relevant to our customer base. Holding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee Source: MLN Connects™ Provider e-News Monday, December 29, 2014 On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Regi ...

New Anti-Fraud Safeguards Under ACA Impact Medicare Billing Privileges

  • Margaret Klasa DC, APN BC
  • Dec 16, 2014
  • Comments

  As a result of new anti-fraud measures under the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) finalized a policy on December 3, 2014 which would revoke or deny Medicare billing privileges from providers that routinely bill for services that do not meet Medicare requirements. This 140 page rule will stop providers from coming back into the system and is designed to protect patients.  Both CMS and provider groups agree that fraud must ...

RAC Procurement Updates - New Contracts Under Pre-Award Protest

  • Margaret Klasa DC, APN BC
  • Dec 08, 2014
  • Comments

It is almost the end of the year and no new Recovery Audit Contractors (RAC) contracts have been awarded. The Centers for Medicare & Medicaid Services (CMS) has recently posted a RAC procurement update stating that as of November 4, 2014, the new contracts for Recovery Auditor Regions 1, 2, and 4 remain under a pre-award protest, which is expected to continue into late summer of 2015. The procurement process continues for Region 3 (Part A / Part B claim reviews), which includes Florida, Ten ...

A Review of Mohs Surgery Claims with Incorrect Coding May Reveal Fraud

  • Cindy Gallee, JD, RHIA, CHC
  • Dec 01, 2014
  • Comments

There are a number of ways a dermatology claim for Mohs surgery can be problematic. But even though there had been a focus on this type of surgery in past years by payers and Recovery Audit Contractors (RACs), legal activity against doctors who allegedly have fraudulently billed Mohs surgery claims has again surfaced, indicating that the issue is not yet resolved. 1 What this means for payers is that since Mohs surgery is a high volume and high expense procedure, it needs to be carefully review ...

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