By now, everyone knows ICD-10 coding starts October 1, 2015.
Starting October 1, 2015, Medicare claims with dates of service after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare claims system will be programmed not to accept ICT-9 codes after September 30, 2015.
However, Medicare announced in…
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule intended to make ACOs and Medicare Shared Savings Plans more practical and attractive to potential providers. The proposed rule was released on December 1, 2014, along with a CMS Fact Sheet.
Longer Lead Time to Develop
In order to provide more development…
On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery.
On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and CMS incorporated the changes regarding global surgery.
Global Surgery
There are three primary categories of global surgery…
In the proposed 2015 Medicare Physician Fee Schedule, CMS is seeking comments regarding expanding coverage for secondary interpretation of diagnostic imaging.
I’m enclosing pages 40370 and 40371 of the proposed Medicare Physician Fee Schedule. The enclosed material sites the Medicare Claims Processing Manual provisions which make is clear that a professional component interpretation service should…
In the recently proposed 2015 Physician Fee Schedule, CMS devoted significant resources to discussing potentially misvalued services, which I believe is code for places where CMS would like to reduce reimbursement. One of the areas is global surgery fees.
CMS has concerns with the 10 and 90 day global surgery fees because these global packages…
CMS has taken a small step to implement President Obama’s executive order instructing federal agencies to eliminate regulations that obsolete or overly burdensome to business.
On October 24, 2011 CMS published the final rule revising Ambulatory Surgery Center (ASC) conditions for coverage to allow patient rights information to be provided to the patient, the patient’s…
The final rule on Accountable Care Organizations (ACOs) has been released by CMS. The final rule implements section 3022 of the Affordable Care Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program.
An advance copy of the final rule may be…
In CMS Advisory Opinion AO-2011-01, CMS has issued a favorable advisory opinion allowing the physician recruitment arrangement with a hospital and a physician practice which imposes a restrictive covenant upon the recruited physician.
Restrictive covenants and recruitment arrangements had initially been prohibited by the Stark Rules. However, bowing to industry comment, CMS amended the physician…
The Centers for Medicare and Medicaid Services (CMS) has issued new proposed fraud and abuse rules in accordance with requirements of the Affordable Care Act (ACA) — first known as the Patient Protection and Affordable Care Act (PPACA).
Section 6501(a) of ACA added Social Security section 1866(j), and required CMS to establish screening procedures for…
The 2010 Medicare Physician Fee Schedule
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers…
