Part B News | Editors' Blog

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.

NGS updates covered diagnosis codes for trigger points

by: Julia Kyles, CPC Feb 8, 2016

National Government Services has made it a bit easier to report trigger points injections. A February update to its pain management LCD adds 17 codes to the list of diagnosis codes that support medical necessity.

Dodgy edit spurs drug screen claims hold

by: Julia Kyles, CPC Jan 28, 2016

Proving that there's always room for more confusion where drug screen billing and coding is concerned, Medicare today announced that it is putting a hold on drug screen claims (G0477-G0483).

Some MACs announce 14 day claims hold in 2016 (Updated)

by: Roy Edroso Dec 28, 2015

~~Two~~ Three MACs serving 13 16 states, citing "technical errors discovered after publication of the MPFS rule," announce they're holding Part B claims for 14 days in early January. (See Update.)

Watch out for ICD-10 claims-processing errors

by: Richard Scott Nov 2, 2015

Six of the 12 Medicare administrative contractor (MAC) jurisdictions, entwining more than two dozen states and territories across the U.S., have reported at least one claims-processing error each, according to a Part B News analysis of the MACs’ publicly reported issues.

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