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OIG scrutiny demands scouring of CCM records as CMS assesses overpayments

08/30/2021

A recent HHS Office of the Inspector General (OIG) audit of selected chronic care management (CCM) claims found many instances of duplicate claims by the same provider, which suggests some practices are not paying attention to their CCM billing. Check now to see if you’re one of them, because CMS is coming for a look-see.

Stop on transgender treatment has limited effect, but future rulings await

08/30/2021

by: Roy Edroso

The latest judicial reversal of patient protections for transgender patients alarms LGBT advocates, but beyond its narrow jurisdiction it is not expected to alter patient care elsewhere regardless of the gender identity of the patient — at least not yet.

CMS lifts annual advance beneficiary notice renewal requirement

08/30/2021

by: Julia Kyles, CPC

You’ll find some good news buried in the updated guidelines for the advance beneficiary notices of non-coverage (ABN): Yearly updates for ABNs related to repeat or continuous treatments will become a thing of the past, effective Oct. 14.

Follow 5 steps to check a sales rep’s claims on a new service or device

08/30/2021

by: Julia Kyles, CPC

A sales representative tries to interest your practice’s physicians in a pain management procedure performed with his company’s latest Food & Drug Administration-approved device. He says it is covered by Medicare and most private payers and gives you information on how to bill the service. Better still, he gives you sample documentation for the procedure. What other steps should you take to make sure you can bill the service?

CMS rescinds Most Favored Nation (MFN) model

08/30/2021

by: Matt Duffy

On August 10, CMS published a proposed rule in the Federal Register to rescind the MFN Model interim final rule, which was published in the Federal Register on Nov. 27, 2020. The rule was supposed to have gone into effect Jan. 1, 2021, but it was never implemented due to a nationwide preliminary injunction issued by the U.S. District Court for the Northern District of California on Dec. 28, 2020.

Per-patient E/M payments fluctuate by state; use them for audits

08/30/2021

by: Julia Kyles, CPC

Use Medicare’s average per-patient payment for all E/M visits in your state as the starting point for your internal review of E/M claims to see how your payments compare to those of your peers in the same area.

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