CMS’ Change Request 6698 for the Medicare Program Integrity Manual clarifies how Medicare claim contractors review authentication of certain orders and supporting medical documentation. This transmittal applies to claim reviews performed by Medicare Administrative Contractors (MACs), Comprehensive Error Rate …
CMS Issues Stricter DMEPOS Supplier Qualifications
September 2, 2010 Leave a Comment
On Friday, August 27, 2010, the Centers for Medicare & Medicaid Services (CMS) issued new regulations (75 Fed. Reg. 52629) that make qualifying for and retaining Medicare billing privileges more stringent for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. The new …
Time Period to Submit Medicare Claims Is Shortened to Twelve Months
August 26, 2010 Leave a Comment
The proposed Medicare Physician Fee Schedule for 2011 (PFS) includes a proposal that Medicare fee-for- services claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of services. This proposal by CMS is aimed at implementing Section 6404 of the Affordable …
Proposed CMS Rule Would Require Group Practices to Notify Medicare Beneficiaries of Alternative Advanced Imaging Suppliers
August 23, 2010 Leave a Comment
Section 6003 of the Patient Protection and Affordable Care Act (PPACA) amended the Stark Law in-office ancillary service exception as applied to physician practices furnishing MRI, CT, PET, and potentially other diagnostic imaging services. The Stark Law prohibits a physician from making a referral for certain …
The Sixty Day Rule: Reporting & Returning Overpayments Under PPACA
August 13, 2010 Leave a Comment
Among numerous changes to the Medicare and Medicaid Program Integrity Provisions, Section 6402 the Patient Protection and Affordable Care Act (“PPACA”) contains urgent requirements for reporting and returning overpayments. The new provision requires certain entities – including providers, suppliers, …
New Statute Sheds Light on Three-Day Rule for Hospital Billing
August 6, 2010 Leave a Comment
On June 25, 2010, President Barack Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. Among other provisions, Section 102 of the legislation broadens the interpretation of what is known as the three-day rule, Medicare's policy for payment for …