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Investigative report suggests suspicious E/M upcoding

by: Ben Penn Sep 20, 2012

A scathing investigative report from the Center for Public Integrity repeats OIG’s E/M utilization trend findings from this past May, while also refuting physician claims that patients got sicker and older in the past decade.

But, as reported in Part B News, the Center finds that CMS is not likely to target possible E/M upcoding in a widespread review.

CMS resumes sending revalidation letters in full force

by: Grant Huang Sep 17, 2012

CMS is in the middle of a five-year campaign to check that all providers and facilities billing Medicare are properly enrolled to do so and, following a brief lull, the process is spinning back up. In July, CMS fired off 15,825 revalidation letters (sent in bright yellow envelopes to get your attention) nationwide. The number has varied from roughly 50,000 a month last fall and winter to only 8,000 a month in April and May of this year.

Cloned EHR notes lead to denials, CMS contractor says

by: Ben Penn Sep 11, 2012

We’ve been ringing the alarm on cloned EHR (electronic health record) visit notes for the past year, but if you’re looking for more proof that these vendor shortcomings can lead to denied claims, then perhaps the warning below from a Medicare administrative contractor (MAC) will suffice.

CPT 2013 contains over 500 changes

by: Laura Evans, Julia Kyles and Kevin McDermott Sep 4, 2012

You’ll find 251 revised and 151 new Category I codes in your CPT 2013 manual. You’ll also see that 100 codes have been deleted. But don’t let the large number of revisions alarm you. In many instances CPT simply adds “qualified health care professionals” to a code’s descriptor. These revisions are most evident in the E/M section of the manual.

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