Part B News | Editors' Blog

CMS: No NCD for gender reassignment surgery, coverage choice up to MACs

by: Roy Edroso Sep 6, 2016

CMS finalized its decision not to have a national policy for Medicare coverage of gender reassignment surgery; instead, individual Medicare administrative contractors (MACs) will decide whether to cover the procedure.

CMS: Providers need a 'relevant' diagnosis for advance care planning

by: Roy Edroso Apr 13, 2016

CMS said in an April 13 provider call that to bill advance care planning (ACP) without a preventive service, you need to show the service is “relevant to the patient’s disease state,” which would seem to mean it requires a diagnosis code.

Modifiers back from the dead?

by: Laura Evans Apr 12, 2016

A report live from this year's AAPC HealthCon shows some payers are accepting X modifiers in place of modifier 59 and more.

Did you settle your practice's appeal?

by: Josh Poltilove Mar 16, 2016

Did your practice participate in the Office of Medicare Hearings and Appeals’ settlement pilot project? If so, we’d love to hear the story of how your practice fared — regardless of whether it agreed to a settlement and got out of the massive backlog of appeals at the administrative law judge level.

Please contact editor Josh Poltilove at jpoltilove@decisionhealth.com or (301) 287-2593.

Long-awaited CMS rule on overpayments gives 6-year lookback, specifies overcoding

by: Roy Edroso Feb 11, 2016

Four years after the proposed rule was issued, CMS has issued the final 60-day overpayment rule, formally called Reporting and Returning of Overpayments. It reduces the look-back period within which the agency can act on determinations that providers have received too much in Medicare funds but sets rigorous standards for determining what an overpayment is – including “over-coded” E/M claims.

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