If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune. In the past, CMS only covered 99406-99407 (Smoking and tobacco use cessation counseling visit…) for a beneficiary with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them stop using tobacco.”
On Nov. 20, 2009, President Obama signed Executive Order 13520, Reducing Improper Payments and Eliminating Waste in Federal Programs, which covers many federal programs including unemployment insurance, supplemental security income, and Medicaid and Medicare fee-for-service, to name a few.
During a teleconference on June 15 of this year, CMS and Comprehensive Error Rate Testing (C.E.R.T.) contractor AdvanceMed revealed that four services would fall under enhanced scrutiny as a result of Executive Order 13520: power wheelchairs, short hospital stays, pressure-reducing support surfaces and chiropractic services.
CMS on Aug. 16 unveiled a new program-integrity tool designed to help providers identify their own errors and reduce the Medicare overpayment rate.
“Comparative billing reports” (CBRs) show providers how they stack up against their peers in the state and nationally in billing for certain risk areas. The first reports were produced for 5,000 physical therapists, but others are underway, Melanie Combs-Dyer, a health insurance specialist in the CMS Provider Compliance Group, tells RMC.
Entering your place-of-service (POS) number on your claim form may seem routine, but a recent OIG audit found that practices are not giving POS numbers the care they deserve.
Based on a review of 100 non-facility Part B claims from 2007, the OIG found that only 10 of the sampled claims had the correct POS code assigned to it, resulting in overpayments of over $4,700. Based on the sample, the OIG estimated that Medicare nationally overpaid physicians $13.8 million in POS coding errors, according to the report.
On August 30, the Office of the National Coordinator for Health Information Technology (ONC) named the first two Certification Authorized Testing and Certification Bodies (ATCBs): CCHIT & The Drummond Group – which means that the HITECH Act stimulus program can now get underway.
BCBS has announced that as of January 1, 2011, American Specialty Health (ASH) will be handling all PPO, indemnity and self-insured plans with a chiropractic benefit. Typical ASH practice is to allow 5 visits and then to require preauthorization for each visit thereafter, with a maximum number of visits per patient averaging 6-8.
The Arizona insurance equality law, ARS 20-461 A.17 and B, requires that BCBS cover all chiropractic care that is “reasonable and necessary.” If ASH routinely limits care to 6-8 visits in the BCBS plans which is widely considered under-treatment, ACS will make this an issue in the same lawsuit that is being filed against the Arizona Department of Insurance (ADOI) to end higher copays and deductibles for chiropractic care. Therefore, ACS has a plan in place to deal with potential problems with ASH.
The world of private insurance, especially health insurance, has been the subject of one shocking expose of exploitation and corruption after another. The abuse of the insurance industry hits providers and beneficiaries equally hard, leaving both communities feeling helpless and with a sense of little or no recourse. The massively deep pockets of the insurance industry and the very limited government oversight that regulates their behavior means that most of the time they get their way. It is when intimidation and allegations of fraud surface in a debate over provider payments that things really get ugly.
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