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Breaking news: Fee schedule has more money for chronic care, more rules for PQRS

11/03/2014

You can start billing for chronic care management (CCM) and earning $40.39 per month per patient Jan. 1, according to the 1,185-page final 2015 Medicare physician fee schedule released Oct. 31.

Target 6 core strategies to overcome TCM code denials, secure payment

11/03/2014

by: Richard Scott

A look at 2013 Medicare claims data reveals high denial rates for the new transitional care management (TCM) codes, but you can secure your reimbursement by billing on the correct day, ensuring you’re the only provider submitting a TCM claim and other key strategies.

On flu shots, check patient eligibility, bill correctly, appeal low payments

11/03/2014

by: Roy Edroso

Now that it’s flu shot season, here are seven tips to not only bill vaccinations correctly, but also get clarity with payers to avoid denials and underpayments.

Configure deals to ensure physicians avoid inducements, legal trouble

11/03/2014

by: Roy Edroso

Help your doctors avoid deals that could snare them in an enforcement net.

Improve employee productivity with proper tracking, growth opportunities

11/03/2014

by: Roy Edroso

Set relevant employee goals — but also encourage achievements that go beyond the expected — to create employee performance tracking processes that not only measure but can actually improve productivity of non-clinical staff.

Modifier 91: Find solution to denials triggered by lab service modifier

11/03/2014

by: Julia Kyles

A sharp increase in utilization, revenue and denials for claims associated with the modifier for repeat lab tests could combine to expose anesthesia and pain management practices to scrutiny, overpayment demands and fraud allegations.

Justice Department steps up use of the False Claims Act to prosecute health care fraud

11/03/2014

by: Marla Durben Hirsch

The department implemented a new procedure so that all new whistleblower cases accusing providers of violating the False Claims Act, which are filed with the department’s civil division, now will be shared with its criminal division as soon as the cases are filed to determine whether a parallel criminal investigation should be opened.

Recovery auditors collected $3.65 billion in overpayments in fiscal year 2013

11/03/2014

by: Marla Durben Hirsch

Recovery auditors collected $3.65 billion in overpayments in fiscal year 2013 and $102 million in underpayments, according to CMS’ latest report.

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