Claims Processing
CMS has posted an "emergency update" to the 2011 Medicare physician fee schedule (MPFS) files, reflecting recent statutory changes and certain technical corrections.
A new OIG report, “Questionable Billing for Medicare Outpatient Therapy Services,” reviews 20 counties with the highest Medicare outpatient therapy payments per beneficiary and overall high outpatient utilization levels in 2009.
The Bethesda Healthcare System, a not-for-profit, two-hospital system in Boynton Beach, Fla., intends to redesign its revenue cycle processes, adding a fully automated financial and clinical patient record.
CMS has issued a new transmittal to update its timeline for implementing claims edits that will deny claims for services ordered or referred by a physician or other eligible professional who does not have an approved file in PECOS.
The National Association of Insurance Commissioners has adopted model language for health insurance exchanges designed to provide guidance to individual states as they establish insurance exchanges as required under health reform.
The Centers for Medicare & Medicaid Services will soon be outfitted with new state-of-the-art fraud fighting analytic tools to prevent wasteful and fraudulent payments in Medicare, Medicaid and the Children's Health Insurance Program.
The Department of Veterans Affairs has announced it will begin using Medicare's standard payment rates for certain medical procedures performed by non-VA providers on Feb. 16, 2011.
In a new sample audit of Medicaid payments, the Office of the Inspector General found the government "inappropriately paid" 6.5 million claims for a total of $724 million. The claims were for personal care service provided by attendants who didn't have proof of federally required qualifications.
Underwriting discipline and an improved cost structure have led to an increased credit rating for Blue Cross Blue Shield of Nebraska.
In order to remain in compliance with Medicare rules, and avoid denials by recovery audit contractors (RACs) and others, hospitals must reduce outpatient procedures performed during inpatient stays.