Medicare recently announced that it will be increasing the frequency of its audits under the Medicare Recovery Audit Program in the near future. Under the Recovery Audit Program, Medicare contracts with auditors who review the records of health care providers to determine if Medicare was incorrectly billed for services and if so, to determine the amounts
Medicare & Reimbursement
Medicare FFS Appeal Process: Good Summary From CMS
By Michael Cassidy on
Posted in Medicare & Reimbursement
The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers brochure has been updated and is now available to order print copies or as a downloadable PDF file. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf or to order hard copies, please visit the MLN Product Ordering Page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the…
CMS PUBLISHES CORRECTED 2008 ASC FEE SCHEDULE
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS PUBLISHES CORRECTED 2008
AMBULATORYSURGERYCENTER FEE SCHEDULE
On February 22, 2008, CMS published corrections to the 2008 payment rates for ambulatory surgery centers. Following is the link to the corrected final rule.
http://a257.g.akamaitech.net/7/257/2422/01jan20081800/edocket.access.gpo.gov/2008/pdf/08-671.pdf
Simple CMS Physician Fee Schedule Explanation
By Michael Cassidy on
Posted in Medicare & Reimbursement
SIMPLE CMS EXPLANATION OF MEDICARE PHYSICIAN FEE SCHEDULE
CMS issued a relatively simple explanation of the Medicare Physician Fee Schedule on February 19, 2008. The release is entitled The Revised Medicare Physician Fee Schedule Fact Sheet for January 2008. It explains the following:
1. the work, practice expense, and malpractice expense components of the RVU formula;…
CMS PUBLISHES PROPOSED RULE ON DURABLE MEDICAL EQUIPMENT SUPPLIER ENROLLMENT WHICH MAY AFFECT PHYSICAL THERAPY PRACTICE
By Michael Cassidy on
Posted in Medicare & Reimbursement
On January 25, 2008 CMS published a proposed rule which clarifies and expands the current enrollment requirements that durable medical equipment and prosthetics, orthotics and supplies ("DMEPOS") suppliers must meet to establish and continue to have billing privileges in the Medicare Program. These provisions may affect the ability of physical therapists to provide DMEPOS to their…
CORF: 2008 Medicare Regulations
By Michael Cassidy on
Posted in Medicare & Reimbursement
CORF SERVICES
I. INTRODUCTION
CORF Services may consist of physician services, physical and occupational therapy services, speech pathology services, respiratory services, prosthetic or orthotic devices and related services, social and psychological services, drugs and biologicals, vaccines and supplies, appliances and equipment. Any of these services may be provided provided a physician first certifies the medical…
Reporting of Cardiac Rehabilatation Services
By Michael Cassidy on
Posted in Medicare & Reimbursement
REPORTING OF CARDIAC REHABILITATION SERVICES
Cardiac rehab services were being reported as CPT 93797 (physician services for outpatient cardiac rehabilitation without continuous ECG monitoring) and CPT 93798 (physician services for outpatient cardiac rehabilitation with continuing ECG monitoring). CMS proposed to establish two new HCPCs codes to report cardiac rehab services, i.e., GXXX 1 (physician services for…
CMS New Years Present: Anti-Markup Rules Effective Date Delayed Until January 1, 2009
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS has presented a New Years gift. The effective date of the Anti-Markup rules with respect to the professional component of diagnostic tests will be delayed until January 1, 2009. Following is the text of the CMS press release. The anti-markup rules for the technical component will not be delayed because they existed by statute prior to the latest proposed regulations.
CMS today issued a final rule delaying until January 1, 2009, the applicability of the anti?markup provisions in §414.50, as revised at 72 FR 66222, except with respect to: (1) the technical component of a purchased diagnostic test and (2) any anatomic pathology diagnostic testing services furnished in space that (i) is utilized by a physician group practice as a "centralized building" (as defined at §411.351 of this chapter) for purposes of complying with the physician self-referral rules and (ii) does not qualify as a "same building" under §411.355(b)(2)(i). This final rule is available for public inspection at the Office of the Federal Register as of 1:17 p.m., today, December 28, 2007, and is effective January 1, 2008. The final rule will be published in the January 3, 2008 Federal Register.
The text below is that of the CMS-approved document that was submitted to the Office of the Federal Register (OFR) for publication and placed on public display on December 28, 2007. The document is pending publication in the Federal Register. This document may vary slightly from the published document if minor editorial changes have been made during the OFR review process. The document published in the Federal Register is the official CMS-approved document.
MEDICARE PROVIDES NEW DEFINITION OF PHYSICAL THERAPIST ASSISTANT
By Michael Cassidy on
Posted in Medicare & Reimbursement
On November 1, 2007, the Centers for Medicare and Medicaid Services ("CMS") released its final Medicare Physician Fee Schedule Rule for calendar year 2008. In addition to announcing CMS’ payment rates for 2008, the final rule includes a new definition of physical therapist assistant and sets forth certain personnel standards for the provision of physical therapy services. Continue Reading MEDICARE PROVIDES NEW DEFINITION OF PHYSICAL THERAPIST ASSISTANT
House Approves 6 Month .5% Medicare Physician Fee Increase
By Michael Cassidy on
Posted in Medicare & Reimbursement
U.S. House approves Medicare physician reimbursement, SCHIP extension bill.
In continuing coverage from yesterday’s briefing, Bloomberg (12/20, Goldstein, Johnston) reports that a "scheduled cut in Medicare payments to doctors will be postponed," and the State Children’s Health Insurance Program (SCHIP) "will be extended at its current enrollment under legislation the U.S. House sent to…