CMS Manual System Department of Health & Human Services (DHHS) Pub 100-08 Medicare Program Integrity Centers for Medicare & Medicaid Services (CMS) Transmittal 361 Date: December 10, 2010 Change Request 6988 SUMMARY OF CHANGES: This CR requires that a mandatory ABN (Advanced Beneficiary Notice), shall be requested as part of the ADR on all claims […]
This tool is provided by AHA — for support and terms and conditions of use, please visit this AHA webpage. Internal tracking of audit activity is essential for managing the RAC process. Hospitals also will need to organize their data to properly respond to the RACTrac survey. In anticipation of needing to assist hospitals in […]
The Red Flags Rule [PDF] The Red Flags Rule: Frequently Asked Questions The Red Flags Rule requires many businesses and organizations to implement a written Identity Theft Prevention Program to detect the warning signs — or “red flags” — of identity theft in their day-to-day operations. The staff of the Federal Trade Commission (FTC) has […]
from CMS website: OPPS: www.cms.gov/HospitalOutpatientPPS/ ASC payment system: www.cms.gov/ASCPayment/
Centers for Medicare & Medicaid Services’ Use of Medicare Fee-for-Service Error Rate Data To Identify and Focus on Error-Prone Providers From the Executive Summary The Improper Payments Information Act of 2002 requires the head of a Federal agency with a program that may be susceptible to significant improper payments to report to Congress the agency’s […]
Documents related to this case: SECONDED AMENDED CLASS ACTION COMPLAINT — Filed in Superior Court of the State of California for the County of Humboldt, Case No.: DR060264, April 16, 2008. VERIFIED ANSWER TO MOTION TO DISQUALIFY JUDGE — Filed Jun 11, 2009. STIPULATION AND ORDER, FORM 8-K AND PRESS RELEASE — Dated July 15, […]
The Affordable Care Act In Action, Securing Medicare Benefits From the Introduction: The Patient Protection and Affordable Care Act (PPACA) includes a series of Medicare reforms that will generate billions of dollars in savings for Medicare and strengthen the care Medicare beneficiaries receive. The new law protects guaranteed benefits for all Medicare beneficiaries, and provides […]
Modifier -59: “Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different […]
The Federal Sentencing Commission defined an “effective compliance and ethics program,” in changes to their Federal Sentencing Guidelines (Section 8B2.1), as published in the Federal Register on April 29. The proposed changes take effect Nov. 1, unless Congress moves to block them. The following contains the amendments: Effective November 1, 2010