CMS must provide better oversight to prevent duplicate audits says GAO study A newly released study by the federal General Accounting Office (GAO) found that the Centers for Medicare and Medicaid Services (CMS) needs to provide better oversight and guidance for provider payment auditors to prevent duplicative post-payment claims review audits. Several types of Medicare contractors conduct postpayment claims reviews to help reduce improper payments: Medicare Administrative Contractors, which process and pay claims; Zone Program Integrity Contractors, which investigate potential fraud; Recovery Auditor Contractors, tasked with identifying on a postpayment basis improper payments not previously reviewed by other contractors; and the Comprehensive ... August 21, 2014 General CMS, Insurance/Reimbursement, Medicare, Audits 0 0 Comment Read More »
Noridian incorrectly denies 300,000 claims for E&M services Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014. Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes ... August 13, 2014 Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
Cal MediConnect lawsuit unsuccessful Last week, the Sacramento Superior Court denied a request to delay implementation of the Cal MediConnect project. In a last minute challenge to the program, the Los Angeles County Medical Association (LACMA) joined a coalition of plaintiffs, including three Los Angeles independent living centers, to file a lawsuit in Sacramento Superior Court to stop the implementation of the project. The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. ... August 8, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
Noridian offering webinars for practices Noridian, the Medicare Administrative Contractor for California, has scheduled a series of one-hour webinars during the month of August. Topics include common errors, global surgery and a series of three webinars titled “Climbing The Ladder To Success.” (For details on each workshop, click on the title.) Continuing education units are offered for most workshops. August 8, 2014 Medicare Noridian, Webinars, Medicare 0 0 Comment Read More »
CMS issues proposed 2015 Medicare payment rule The Centers for Medicare and Medicaid Services (CMS) recently published the 2015 proposed Medicare physician payment rule in the Federal Register. The proposal contains several notable changes. The rule expands the services eligible for telemedicine reimbursement (psychotherapy services and the annual wellness visit). It also extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition ... August 4, 2014 Medi-Cal, Medicare Insurance/Reimbursement, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Medicare's financial outlook improves Trustees overseeing Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors, said Monday in a report that the program won’t run out of money until 2030 – that’s four years later than projected last year and 13 years later than projected at the passage of the Affordable Care Act (ACA). The outlook for Medicare improved largely because of lower-than-expected hospital spending and savings resulting from the ACA. The effect of the new law encouraged providers and Medicare Advantage insurers to deliver care more cost-effectively and ... August 4, 2014 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
IOM report says financing for physician residency programs needs overhauling to meet nation's needs A report by the Institute of Medicine shows that the U.S. should significantly reform the federal system for financing physician training and residency programs to ensure that the public’s $15 billion annual investment is producing the doctors that the nation needs. Current financing – provided largely through Medicare – requires little accountability, allocates funds independent of workforce needs or educational outcomes, and offers insufficient opportunities to train physicians in the health care settings used by most Americans, the report says. For decades, teaching hospitals have received the majority of Medicare's funding ... August 4, 2014 General Insurance/Reimbursement, Physician Workforce, Residents and Fellows, Medicare 0 0 Comment Read More »
CMA, AMA and others urge CMS to delay new rules authorizing multi-hospital systems to establish system-wide medical staffs The California Medical Association (CMA), the American Medical Association and dozens of other state and specialty medical associations have asked the Centers for Medicare & Medicaid Services (CMS) to delay for one year new Medicare rules that would allow multi-hospital systems to establish system-wide medical staffs. CMA commented extensively on this and prior iterations of this rulemaking expressing serious concerns about the proposed amendments to the CoPs and their impact on medical staff self-governance. CMA believes that medical staff self-governance is a vital part of a carefully crafted system designed ... July 15, 2014 General Medicare, Organized Medical Staff, CMS, Hospital Medical Staff 0 0 Comment Read More »
Deadline to submit meaningful use hardship exception is July 1 Beginning January 1, 2015, Medicare physicians who have not successfully attested to meaningful use of a certified electronic health record (EHR) system may incur payment penalties, as mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act. These payment adjustments will be 1-2 percent of total Medicare charges in 2015, to 2 percent in 2016 and 3-5 percent in 2017 and beyond. The 2015 penalties are based on 2013 reporting data. Physicians who failed to successfully demonstrate meaningful use in 2013 can apply for a hardship exception ... June 25, 2014 Medicare EHR, Electronic Health Record, HIT, Medicare, Certified EHRs 0 0 Comment Read More »
Medicare Advantage plans to see a modest increase in payments The Centers for Medicare and Medicaid Services (CMS) announced this week that Medicare Advantage plans would see a 0.4 percent boost in payment rates for 2015. This small payment boost is a change from CMS's February proposal that would have reduced Medicare Advantage plans payment rates by 1.9 percent. This announcement comes on the heels of new data that predicts falling Medicare costs due to healthier baby boomers aging into the system. Healthier beneficiaries in Medicare have led to a downward drop in risk adjustment for the program. CMS has also ... April 16, 2014 Medicare Medicare, Medicare Advantage, GPCI 0 0 Comment Read More »
