According to the website on PQRS from the Center for Medicare and Medicaid Services (CMS), “Beginning in 2015, if the eligible profes-sional or group prac-tice does not satisfactorily submit data on Physician Quality Reporting System quality measures, a 1.5 percent payment adjustment will apply. To avoid the 2015 adjustment, an eligible professional must satisfactorily report Physician Quality Reporting System quality measures during the 2013 reporting period (Jan. 1-Dec. 31, 2013).”
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Medicare revalidation, DMEPOS fee still prompt questions among ODs
“Medicare covers post-op eyeglasses for cataract patients only if the glasses are provided by a DMEPOS supplier who is enrolled in Medicare,” Dr. Jordan said. “If the optometrist is not enrolled in Medicare for DMEPOS, then the glasses are not covered. Neither the doctor nor the patient can obtain reimbursement for the glasses from Medicare if the supplier is not enrolled. If a Medicare beneficiary wants to pay out-of-pocket for eyeglasses from a supplier who is not enrolled in Medicare, she or he may do so, but the doctor should be sure to explain to the patient that the glasses would be covered if they were obtained from another supplier who is enrolled in Medicare. In addition, the doctor should be certain to have an ABN form signed by the patient acknowledging that although she/he could have these glasses covered elsewhere she/he agrees to pay the doctor out-of-pocket and that he or she cannot get reimbursement from Medicare.”
2013 Brings Many Changes for Therapists in the Medicare Program
Tagged as: Bells And Whistles, Bill Medicare, Bonus Payment, Cmrs, Corf, Functional Limitation, Healthcare Reimbursement, Home Health Agencies, Medicare Patients, Medicare Program, Outpatient Therapy, Party Hats, Private Practice Settings, Private Practices, Quality Measures, Reimbursement Services, Ringing In The New Year, Skilled Nursing Facilities, Therapy Providers, Therapy Settings
Texas Medicare Supplement Insurance
You’d like to think all your medical services are covered, but unfortunately, even with Medicare supplement insurance, that is simply not the case. Most Medicare supplement policies pay only for services Medicare decides are “medically necessary”. If you are unsure what these exact services are, you can look in your Medicare Summary Notice. If you do receive a bill for services, you will need to review your notice statement to find out if you owe anything extra. All medical providers and doctors that accept Medicare should know beforehand if a procedure is approved by Medicare and the rule of thumb is if it’s an approved charge the supplement is required by law to start paying its share. Fairly simple and less worrisome., easy actually.
Hospice and Caregiving Blog: Changes to Medicare Hospice Claim Form
The Centers for Medicare & Medicaid Services (CMS) recently issued CR6791 which requires hospice agencies to report a separate line item for each time the levelof care changes.For hospice claimssubmitted on or after April 29, 2010, hospices should report separate line itemsfor the level of care each time the level of care changes. This includes revenuecodes 0651 (Routine Home Care), 0655 (Inpatient Respite Care) and 0656 (General Inpatient Care).Read the complete release on the CMS website.
Home Health Medicare Claims / Eventish
Learn To Submit A Compliant Claim To Medicare For proper reimbursement, the home health agencies need to submit a clean claim for to Medicare. But in our haste to “get the bill out the door” and reimbursement “in the door” are red flags in coding and OASIS inadvertently triggering selection of our records for review and possible denials? Not only the codes and OASIS M items can result in a denial of payment but also the failure to adequately document the physician face to face, skilled services, homebound status, and the focus of the plan of care put our claims at risk and are areas of increased scrutiny by RACs and the OIG in 2013.
Medicare Terminology To Know
Medicare summary notice (MSN) deals directly with the beneficiary or the person covered under Medicare. The MSN replaced the Explanation of Medicare Benefits form in 2001. This is an easy to read document sent to the Medicare holder every month that allows them to see their Part A and Part B claims. The MSN also holds the deductible status. Basically it is an information sheet. Often when a patient receives the MSN they think it is a bill. It is important to understand that this is not a bill but rather an explanation of what has transpired the previous month under their Medicare coverage.
GAO: Additional Imaging Self
Additional imaging service referrals by providers who self-referred cost Medicare approximately $109 million, according to a U.S. Government Accountability Office report. The report, “Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions,” examined the rate of imaging referrals among providers who self-referred and those who did not, and the accompanying costs. Results showed that from 2004 through 2010, the number of self-referred MRI services increased by more than 80 percent, while the number of non-self-referred MRI services increased by only 12 percent. Overall, self-referring providers referred roughly twice as many imaging services in 2010 as providers who did not self-refer, according to the report. GAO estimates self-referring providers likely made 400,000 more referrals for advanced imaging services in 2010 than they would have if they were not self-referring, resulting in an approximate cost of $109 million to Medicare. Moreover, these additional referrals pose a risk to patient safety due to increased radiation exposure, according to the GAO report. The differences in referral rates between self-referring and non-self-referring providers remained after accounting for practice size, specialty, geography and patient characteristics, according to the report. To address the high rate of imaging service referrals among self-referring physicians, GAO made three recommendations to the administrator of CMS: 1. Insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not. 2. Determine and implement a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service. 3. Determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers. While HHS said it would consider the third recommendation, it did not concur with the first two. For the first recommendation, HHS said CMS believes a new checkbox on the claim form would be complex to administer and may not characterize referrals accurately. For the second recommendation, CMS commented that an additional payment reduction may cause providers to refer more services in an effort to maintain their income, according to the report.