Part B News | Editors' Blog

by: Julia Kyles, CPC Oct 18, 2017

Don't believe the myth that enforcers only keep the big fish in health care fraud schemes — hospitals, diagnostic providers, pharmaceutical companies and so on — and let the small fry such as doctors and medical practices go.

Coding and billing guidelines — read 'em or weep.

by: Julia Kyles, CPC Oct 13, 2017

This $2 million settlement announcement illustrates the importance of keeping up with — and following — coding and billing guidance from AMA and your Medicare contractor.

Pharmacy expert on opioid issues: Check the guidelines against your own practices

by: Roy Edroso Oct 12, 2017

A longtime pharmacy executive shares his thoughts about the responsibilities and options of providers toiling in the current opioid crisis.

MACs to replace MR with TPE

by: Julia Kyles, CPC Sep 20, 2017

CMS is taking the training wheels off the targeted probe and educate (TPE) progam pilot that it rolled out in May and expanded in June. Effective Oct. 1, your Medicare administrative contractor (MAC) will begin to phase out most forms of medical review and replace them with TPE.

Third health system settles over alleged swap of new and established patient E/M codes

by: Roy Edroso Aug 28, 2017

On the heels of two similar settlements, a Baltimore health system has settled a case for $122,928 in which it was accused of getting the doctors whose practice it had acquired to bill established patients as if they were new, inflating their charges.

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