Replace 90658 With a Q Code, After Jan. 1

Get ready to change your flu vaccine product code 90658 to one of four Q codes. For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physici...

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CMS Slashes Conversion Factor for 2011, Establishes Preventive Visit Codes

Get ready for another year of nail-biting to find out if your Medicare payments will be slashed. “The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217,” notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in th...

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Handle Your Hand, Wrist Diagnoses With Care by Pinpointing Anatomic Site

Here’s how to differentiate the tiquetrum from the trapezium. Doctors dealing with hand procedures don’t only treat carpal tunnel syndrome, and it’s up to you to link the correct diagnosis to the upper-extremity repair codes. Use this anatomic dr...

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Place-of-Service Codes Caused $13 Million in Overpayments

Double check POS 11 shouldn’t be 22 — or 24. 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 r...

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CMS Clarifies How to Report Audiology Services

Look for a physician order for diagnostic audiology tests. If you thought CMS’s May transmittal on coding for audiology services was the last word on the subject, think again. On July 23, the agency rescinded the May directive and issued new guidance...

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Recovery Audit Contractors: Know These RAC Fast Facts

RACs are just another tool in the government’s arsenal to collect improper payments.

You’ve got so many compliance acronyms flying at you every day that you may not be able to differentiate your RAC from the OIG. Know these quick facts about RACs to stay better informed.

  • Recovery audit contractors (RACs) detect and correct past improper payments so CMS and the MACs can prevent such problems in the future
  • RACs are hired as contractors by the government, and they can can collect “contingency fees,” which means that they get a percentage of the amount that they recover from providers who were paid inappropriately The maximum RAC lookback period is three years, and they cannot review claims paid prior to Oct. 1, 2007
  • Between 2005 and 2008, RACs involved in the original demonstration project recovered over $1.03 billion in Medicare improper payments, but referred only two cases of potential fraud to CMS, according to a February OIG report on the topic, which noted that “because RACs do not receive their contingency fees for cases they refer that are determined to be fraud, there may be a disincentive for RACs to refer potential cases of fraud.”
  • Unlike RACs, the OIG is a government entity. Although the OIG also performs reviews and audits and seeks improper payments, the OIG does not collect contingency fees.

For more on the RAC program, visit www.cms.gov/rac.

Part B Insider. Editor: Torrey Kim, CPC

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Medicare Physician Pay Cut Update

On Tuesday evening, the Senate passed H.R. 4691, which freezes the Medicare conversion factor at current levels through March 31.

Because of this vote, you will not face the 21% pay cut until April 1, explains Part B Insider editor,…

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CMS Tells MACs to Hold Claims For 10 Days

The latest on the 21 percent Medicare pay cut.

If your practice leans heavily on Medicare for reimbursement, expect your cash flow to taper off a bit.

CMS has instructed the MACs to hold claims for the first ten business…

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Physician Fee Schedule Update: An Extension for the Temporary Conversion Fix?

Fear not: The CF may stay until autumn, but the current snow storm is delaying the official word. Practices that were looking for a permanent change to the sustainable growth rate (SGR) formula before March 1 may come up empty-handed. However, Congress appears to be planning to offer an extension of the pay cuts that you’re [...] Related articles:

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Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link. Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well. Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...] Related articles:

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CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow. CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows: Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued. Modifier GX — [...] Related articles:

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