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Restructure Will Happen Before CMS Gets a New Chief The Centers for Medicare & Medicaid Services (CMS) is being restructured, despite lacking a Senate-confirmed administrator since the last one stepped down October 2006. The new structure adds a new pricipal deputy administrator, reporting directly to Acting CMS Administrator Charlene Frizzera. Firzzera announced the changes Feb. […]
Expect More Programs Like Recovery Audit Contractors President Obama signed a presidential memorandum directing all federal departments and agencies to “expand and intensify their use of payment recapture audits under their current authority,” on March 10. No additional legislation is needed, therefore, for the agencies to enact programs similar to CMS’s Recovery Audit Contractors program. […]
Scheduled 21% Pay Cut for Physician Services to Medicare Beneficiaries Delayed 30 Days On March 2, the US Senate once again delayed enacting a scheduled 21% payment cut for physicians who provider Medicare services. The lopsided vote, 78-19, concerns the Temporary Extension Act of 2010 (H.R. 4691), and includes extensions to unemployment benefits, and […]
AMA Letter to Senate: Repeal Medicare Payment Formula This Month The AMA issued a statement calling on the Senate to “use this time wisely to repeal a broken payment formula.” The House has passed legislation that would have repealed the funding formula, and now the Senate needs to act, according to the statement. The […]
CMS Health Information Technology (HIT) Links and Documents Health Information Technology The American Recovery and Reinvestment Act of 2009 (Recovery Act) was signed into law by President Obama on February 17, 2009. The law includes the Health Information Technology for Economic and Clinical Health Act, or the “HITECH Act,” which established programs under Medicare […]
Modification to Accommodate the Acute Care Episode (ACE) Demonstration from the CMS website: Pub 100-19 Demonstrations SUMMARY OF CHANGES: The Centers for Medicare and Medicaid Services (CMS) issued change request (CR) 6001 on June 27, 2008 to implement the necessary requirements for the ACE demonstration project. Under the ACE demonstration, CMS is issuing a single […]
FAQs on Observation, Condition Code 44 from the CMS website QUESTION: May a hospital report drug administration services, such as therapeutic infusions, hydration services, or intravenous injections, furnished during the time period when observation services are being reported? ANSWER: The Medicare Claims Processing Manual (Pub 100-4), chapter 6, section 290.2.2 states that “observation services […]
What is the CMS Medically Unlikely Edit (MUE) program? The CMS Medically Unlikely Edit (MUE) program was developed to reduce the paid claims error rate for Medicare claims. MUEs are designed to reduce errors due to clerical entries and incorrect coding based on anatomic considerations, HCPCS/CPT code descriptors, CPT coding instructions, established CMS policies, nature […]
