Tag: medicare benefits

Medicare-Advantage-Bill-Response-To-Complaints

The Medicare Advantage Bill Was Crafted In Response To Complaints

The bill was crafted partly in response to rising complaints among seniors over aggressive marketing practices for Medicare Advantage plans. U.S. Sens. Maggie Hassan, D-N.H., and Dr. Roger Marshall, R-Kansas, have introduced the bipartisan Medicare & You Handbook Improvement Act, which is meant to ensure that when seniors assess their Medicare coverage options, they have the necessary […]
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Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage plans hold up their end of the contract with CMS, and provide, at a minimum, a fair reimbursement for services delivered. The physician advisor is a fast-growing specialty that has evolved into so much more than someone who performs endless chart reviews for observation status determinations, medical necessity reviews, peer-to-peer conversations with payors, […]
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What are the Costs and Benefits of Medicare Audits?

For most readers the results of this analysis will be amazing but true. Longtime RACmonitor contributor and R1 Physician Advisory Services Vice President Dr. Ronald Hirsch recently pointed site Publisher Chuck Buck in the direction of something that, frankly, wowed him: a PhD thesis from a young Columbia University student on the topic of the […]
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  • March 18, 2019

What the Presidential Budget Means for Medicare

President Trump’s fiscal year (FY) 2020 budget allows for $87.1 billion in discretionary budget authority and $1.2 trillion in mandatory funding for the U.S. Department of Health and Human Services (HHS). Although the Centers for Medicare & Medicaid Services (CMS) commands the lion’s share of HHS’s budget, the Trump administration has found ways to cut $395 million […]
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  • March 8, 2019

Medicare Advantage Plans and the Two-Midnight Rule

Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting comments and questions. I can’t […]
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  • March 8, 2019

“Defensive” Undercoding Is Indefensible

Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider Reimbursement […]
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  • February 20, 2019

CMS Eliminates Reporting of Functional Limitation Codes

CMS also has updated its therapy manuals, making elimination of FLR official. Many therapy providers, at hospital outpatient departments and private-practice clinics alike, were reluctant to stop submitting functional limitation reporting codes and impairment modifiers until they could see the guidance clearly written in black and white in the associated therapy policy manuals. While the […]
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  • February 13, 2019

New Medicare Enrollment Application

There is a new version of the CMS-855I Medicare Enrollment Application, which physicians and non-physician practitioners may begin using immediately. Medicare Administrative Contractors will accept the previous version of the application (7/2011) through April 30, and then require you to use the new version (12/18). What’s Changed? The Centers for Medicare & Medicaid Services (CMS) has made the […]
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  • January 15, 2019

Non-Coverage Denials: Cause and Cure

Explanation of Medicare Benefits (EOB) error message 96 Non-covered charge was the No. 1 reason for claims denials in December in all of Medicare Jurisdiction H, according to the region’s Medicare Administrative Contractor (MAC). “Prior to performing or billing a service, ensure that the service is covered under Medicare,” Novitas Solutions says on their website. This should be […]
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