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Louisiana Leads The Nation In Medicare Overbilling

Louisiana posted the highest rate of Medicare being overbilled for services in the nation in 2015, with providers charging an estimated $1.25 billion more than they should have, according to a federal report. Best Medical Coding Course!

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Senate Passes Medicare Access and CHIP Reauthorization Act 92 to 8 – Avoids Payment Cuts

Closing in on two hours before the midnight deadline, the U.S. Senate on Tuesday April 14th, 2015 passed the bill in a vote of 92 to 8 to permanently end the sustainable growth rate (SGR) formula that threatened to cut physician Medicare reimbursement by 21 percent.

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Medicare Coding Errors to Avoid: Add-on, Place of Service, and Modifiers

Medicare audits have revealed recurring errors in billing with add-on and place-of-service codes. In addition, Medicare continues to receive claims that appear to be duplicate because they lack an appropriate modifier. Here are some guidelines for correct billing.

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CMS Releases The 2015 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) issued the 2015 Medicare Physician Fee Schedule (Medicare PFS) on October 31, 2014.

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CMS Withdraws Medicare Secondary Payer Proposed Rule

A proposed rule that was expected to outline how Medicare’s interest should be protected in cases of settlements for future medical care was withdrawn Oct. 8 by the Office of Management and Budget.

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An Out-of-Control Medicare Audit

What happened to Eastern Carolina internal Medicine (ECIM) in Pollocksville, North Carolina is a provider’s nightmare about government oversight run amok.

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CMS Opens Vaults, Releases 2012 Medicare Charge Set

The CMS is practicing what it preaches: The agency decided to open several large data sets for consumers, researchers and entrepreneurs to use.

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Medicare Payments Exposed

For the first time, the federal Centers for Medicare and Medicaid Services (CMS) has made public a database showing what it pays out to individual physicians.

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Two-Midnight Rule Will Short-Change Hospitals, Providers Say

Healthcare providers say Medicare is going to short-change them on patients who spend fewer than two nights in the hospital, and delaying implementation of a new payment policy until October won’t change that.

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Just the RAC Facts: Controversial Program Roots Out Fraud, Waste in Medicare

Here are the facts: Medicare is one of the largest insurance programs in the United States, and every year it helps insure more than 49 million seniors and other beneficiaries. And, for a variety of reasons, its prognosis is anything but certain; estimates indicate that Medicare will be bankrupt by 2026.

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OIG Seeks Improvements To RAC Program, Enhanced CMS Efforts To Stop Improper Medicare Payments

The OIG has called on CMS to strengthen activities to prevent improper Medicare payments, including enhancements to the Recovery Audit Contractor (RAC) program.

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OIG: Room To Improve Medicare Audits

Contractors hired by Medicare to audit the payment records of healthcare providers have a good track record spotting improper billing, the Department of Health and Human Services Inspector General concluded in a recent report, but legitimate concerns exist.

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AHA Survey: Medicare RAC Audits Up 47% Since Last Year

The number of Recovery Audit Contraction (RAC) requests for medical claims reviews has increased “dramatically” since 2012, according to the American Hospital Association’s (AHA) newest RACTrac survey.

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Medicare’s 140,000 New Diagnosis Codes Doctors Hate

The health care industry is “not progressing at a suitable pace” to be ready for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the insurance billing process, a new analysis shows.

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CMS Adjusts Medicare RAC Documentation Limits

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Plan for PET scans draws docs’ ire

In an effort to scale back use of high-priced imaging of questionable value in cancer treatment, Medicare has proposed ending reimbursement for post-treatment positron emission tomography scanning

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