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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 […]
Here is the relevant text in the Change: 3.14 – Clinical Review Judgment (CRJ) (Rev. 338, Issued: 05-14-10, Effective: 04-23-10, Implementation: 06-15-10) A. Contractors to Which This Section Applies This section applies to ACs, MACs, CERT, RACs, PSCs, and ZPICs, as indicated below. B. General The CRJ involves two steps: (1) the synthesis of all […]
The Affordable Care Act: New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars The Affordable Care Act will improve and expand consumer protections, strengthen Medicare, and reduce health care costs. One important way it achieves these goals is by improving government-wide efforts to fight fraud and waste. The new law contains some critical […]
The following resources are easily reached via the listed links: HealthcareReform.gov – archived main site for reports, timelines, news reports and contacts. After the Affordable Care Act became law, this site was launched to provide resources. Healthcare.gov Reports on Health Reform: HHS Reports (archived) Health Care Video Chats (archived) Online Series on Health Reform (archived) […]
Procedures That Will Only be Paid as Inpatient CY 2010 This is the Federal Register/Vol. 74, No. 223/Friday, November 20, 2009/Rules and Regulations Download Links: CMS Inpatient Only List for CY2010 67.58 kb IP Only list begins on page 60947 Zip file of all addenda for CY2010 There are 14 […]
Summary Judgement Bars Prosecution of Former Compliance Officer A hospital system’s corporate integrity agreement (CIA) officer and in-house counsel successfully argued that the statute of limitations barred a False Claims Act (FCA) complaint against her, according a ruling filed by U.S. District Court for the Southern District of Florida (Court), dated April 16, 2010. The […]
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
RAC 101 Video Posted by CMS CMS posted a recording of a RAC 101 seminar conducted by Connie Leonard and Commander Marie Casey, earlier in April. The video includes a short Q&A period at the end. You can turn the captioning on/off or see other videos using the player’s controls:
