Under the WCMSA Guidelines, CMS has the right to recovery. Over 1/3 of Medicare recipients have a Medicare Advantage Plan (MAP). These plan providers have asked for the same recovery rights that CMS has. The last sentence in Section 4.1.3 of the new Self-Administration Toolkit takes the ...
View our recorded webinar on COVID-19 and CMS Changes to Billing Guidelines. Our presenters will explore the latest guideline changes and discuss how to use data insights to drive your future planning. We’ll focus on potential bottom-line impacts, including: Increased access to telehealth for...
her services in addition to the Medicare reimbursement it receives for training residents.The preprinted form, called a "teaching physician statement," contained standard language that would normally be documented by a teaching physician in real time (e.g., "saw and evaluated the patient, discussed...
is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines....
The new policy, which went into effect Oct. 1, 2017, allows surgeons to bill patients for a cosmetic blepharoplasty surgery if it is performed on the same eyelid and on the same day as functional or medically necessary ptosis surgery. Long-standing Medicare National Correct Coding ...
Providers that bill Medicare Advantage or Medicare Part C (“MA”), and most particularly capitated provider groups, should carefully watch a recent lawsuit Providers that bill Medicare Advantage or Medicare Part C (“MA”), and ...
The Centers for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services. CMS oversees many federal healthcare programs, including those that involve health information technology such as the meaningful use incentive program for electronic health records (EHR...
Additionally, the proposal addresses the determination of discarded amounts and refund amounts, clarifies the use of the JW modifier for Medicare Advantage plans, makes technical changes to streamline the text, and requires the JZ modifier for drugs furnished but not administered by the ...
In November 2024, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule addressing, among other things, the Medicare Parts A and B overpayment provisions of the Affordable Care Act (the “Final Rule”). It...more ...
Section 1862(a)(2) of the Social Security Act prohibits Medicare from paying for items or services for individuals who have no obligation to pay for those items or services. This "no legal obligation to pay" payment exclusion means that Medicare cannot cover items or services for individua...