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Medical Billing Codes Key to Fraud Case Against 2 Erie Oral Surgeons

By |August 8th, 2016|

John F. Lehrian, who is retired, and David E. Palo, of what was known as Lehrian & Palo Oral Surgery, 100 State St., pleaded not guilty to federal charges that they the defrauded insurance companies of more than $323,000. They were indicted July 12 on charges of health care fraud. The government is alleging Lehrian […]

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Final 2016 Medicare Physician Fee Schedule Released

By |November 7th, 2015|

The MGMA reports that the final 2016 Medicare physician fee schedule has been released.

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule (PFS) for 2016.

Key policies finalized in the 2016 payment rules include:

Finalizing the Home Health Value-Based Purchasing model.
Finalizing updates to the “Two-Midnight” rule.
Finalizing the End-Stage Renal Disease Quality Incentive […]

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Medicare Reimbursement Rates Get a Small Increase

By |July 16th, 2015|

California Medical Association (CMA ALERT) – The CMS announced that a 0.5% increase will be made for Medicare reimbursement rates, which are effective starting July 1, 2015 to December 31, 2015.

The increase to Medicare reimbursement rates is an effect of the Medicare Access and CHIP Reauthorization Act, signed in April 2015. CMS has released the […]

Medicare Fraud – Taken For a Ride By Ambulance Companies in New Jersey

By |April 15th, 2015|

A four-month Medicare fraud crackdown targeting ambulance service fraud has resulted in 11 New Jersey-based ambulance service providers relinquishing their licenses this year, according to the New Jersey Department of Health. However, as many as 20 to 25 companies reportedly have closed, remaining providers say. The Garden State costs Medicare more than any other state for […]

Government Recovers $3.3 billion in Fiscal 2014 Federal Health Program Fraud

By |March 19th, 2015|

WASHINGTON–The government recovered $3.3 billion in fiscal 2014 from individuals and companies that tried to defraud federal health programs, part of an effort by the Obama administration to improve enforcement and prevent abusive billing practices.

The administration recovered $7.70 for every dollar spent investigating health-care-related fraud and abuse in the past three years, according to a […]

New Medicare Rules Aim to Reduce Suspicious Billing Abuse

By |December 6th, 2014|

Announced in the Wall Street Journal on Dec 3, 2014, the Obama administration has strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government.

Here’s a quick summary of the key points / changes in this important federal program:

move represents a significant shift in how the […]

New Medicare Rules Aim to Reduce Suspicious Billing Abuse

By |December 3rd, 2014|

Announced in the Wall Street Journal on Dec 3, 2014, the Obama administration has strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government.

Here’s a quick summary of the key points / changes in this important federal program:

move represents a significant shift in how the […]

Second quarter PQRS interim claims feedback data available

By |November 27th, 2014|

Eligible professionals (EPs) who reported at least one PQRS quality measure during 2014 via claims-based reporting can access their data on a quarterly basis using the 2014 PQRS Interim Feedback Dashboard. The Centers for Medicare & Medicaid Services (CMS) announced that second quarter interim reports are now available for EPs who submitted data via claims […]

Be Prepared for the X Factor – 4 New HCPCS Modifiers Effective Jan 1, 2015.

By |September 7th, 2014|

Article By Heidi Stout, CPC, COSC, CCS-P

In an effort to reduce inappropriate claim payments due to incorrect use of modifier 59, The Centers for Medicare and Medicaid Services (CMS) will roll out four new HCPCS modifiers to describe specific circumstances when it is appropriate to override a CCI edit.   These -X modifiers become effective on […]

CMS Changes to the Use of Modifier -59

By |August 26th, 2014|

CMS is establishing four new HCPCS modifiers to define subsets ofthe – 59 modifier, a modifier used to define a “Distinct Procedural Service.”

EFFECTIVE DATE: January 1, 2015
Unless otherwise specified, the effective date is the date of service.

IMPLEMENTATION DATE: January 5, 2015

Disclaimer for manual changes only: The revision date and transmittal number apply only to red
italicized material […]