Your Medicare Administrative Contractor (MAC) and other Medicare auditors are free to review claims history for data mining and during complex review to determine whether payment for a claim is appropriate, CMS says in transmittal 367 to its Program Integrity Manual.

You must take your documentation to the next level to avoid being snared by carriers who use tougher medical necessity standards on one of the most common service types: established E/M visits. Extremely high error rates – averaging 51% and 91% – were found for codes 99211-99215 by one carrier during its most recent medical review.
 

You and your peers must double down on documentation for prothrombin time or risk getting costly denials thanks to a marked growth in post-payment reviews that challenge prothrombin time billing. At least three Medicare Administrative Contractors (MACs) have posted Comprehensive Error Rate Testing (CERT) findings that show a clear focus on services with physician orders, including prothrombin time.
 

Expect payments for three ECG monitoring codes and a heart catheter insertion and placement code to change slightly due to fee schedule changes your Medicare Administrative Contractor (MAC) needs to implement by April 4, according to CMS transmittal 2167 to its Claims Processing Manual.

Summary: These charts compare E/M utilization changes at the code level for primary care vs. specialists over a five-year time window, from 2005 to 2009. Have E/M services shifted from lower level to higher-level codes? Are the trends the same for primary care as for specialists? This Benchmark attempts to find out.

CMS and the Office of the National Coordinator for Health Information Technology (ONC) are hard at work on creating the official proposed rule for stage 2 meaningful use. What you can expect is found in the very first draft, the request for information (RFI) version of stage 2 measures.

CMS has changed the global days on simple repair codes (12001-12018) from 10 to 000 effective 1/1/11. Was it CMS’s intention to start allowing payment for post-op visits related to providing these procedures, such as providers now billing a low-level E/M involving suture removal?