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It's a familiar scenario: A provider is accused of letting unqualified, improperly supervised employees perform services and billing for their work. It is a scenario we associate with small practices, not a large health system with multiple locations and — one assumes — a robust compliance policy.

According to an email from WPS GHA, some practices forgot to take a very important step at the start of the year -- and the ommission could be costing them money.

One of the experts who talk about how providers catch the pay for performance wave in our current issue of Part B News is skeptical that smaller practices have the resources to fulfill value-based contracts.

With a federal government shutdown more than likely on Friday, CMS has issued guidance that says it will fulfill its necessary functions regardless.

After Congressional inaction allowed the Medicare therapy cap exception to expire on Jan. 1, CMS tells Part B News that it will hold all Medicare claims with the KX modifier “for a short period of time” to make billing those claims easier when, as hoped, Congress reinstates the exception retroactively sometime this year.


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