CERT Program Monitors CMS FFS Improper Payments - $36 Billion in 2013

  • Margaret Klasa DC, APN BC
  • Jul 29, 2014
  • Comments

On July 9, 2014, the U.S. government was subject to a frenzy of media attention after the announcement that federal agencies made nearly $100 billion in improper payments in 2013. This information was reported after a hearing held by the House Oversight government operations subcommittee. While this improper payment amount encompasses all government agencies, the Medicare (Fee-for-Service) program topped the list of all improper payments made by government agencies at $36 billion. The remaining ...

Announcing Context's New Blogs! Expert Analysis for Payers & Providers

  • Kate Armbruster
  • Jul 29, 2014
  • Comments

Context 4 Healthcare is excited to announce the launch of three brand-new blogs designed to explore and analyze issues affecting the payer and provider communities. Sign up to receive email updates for one or all of our new blogs, and immediately benefit from the articles and analysis provided by Context's experts. Context's Compliance Edge blog is focused on providers and industry issues associated with real-time clinical claim editing used to maximize reimbursements. This blog is authored b ...

4 Ways for Payers to Detect Fraudulent Therapy Services

  • Cindy Gallee, JD, RHIA, CHC
  • Jul 23, 2014
  • Comments

In a July 2014 news release, the Department of Justice announced the guilty plea of a Florida podiatrist to one count of  healthcare fraud for billing Medicare falsely for Micro-vas treatments. At issue were the podiatrist’s claims to Medicare for therapy services that were non-covered, were incorrectly coded as physical therapy, and were coded as the doctor performing the service when he had not. Micro-Vas is a trademarked device that provides deep penetrating electrical stimulatio ...

RAC Audit Identifies Overpayments for Billing Incorrect DME Codes

  • Margaret Klasa DC, APN BC
  • Jul 22, 2014
  • Comments

RAC Region C contractor Connolly posted 2 automated reviews for DME providers on April 8, 2014, regarding Mechanical In-exsufflation Devices, High Frequency Chest Wall Oscillation Devices, and Urological Supplies. Per the contractor’s description of these issues, overpayments were identified where ICD-9-CM coding was not in accordance with billing requirements outlined in Local Coverage Determinations (LCD) for DME devices. Mechanical In-Exsufflation HCPCS CODES Group  ...

Use of Clinical Editing to Identify Medical Necessity for Cetuximab

  • Margaret Klasa DC, APN BC
  • Jul 22, 2014
  • Comments

RAC Region B contractor CGI posted a semi-automated review on March 26, 2014, for outpatient providers regarding the medical necessity for the drug Cetuximab. Per the contractor’s description of this issue,  clinical editing to identify potential incorrect billing occurring for Cetuximab claims billed with an ICD-9-CM code that does not support medical necessity, according to existing Medicare policy, FDA labeling, accepted guidelines, approved compendia, or other Medicare rules and ...

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