TCN Medical Coding Blog

New Medicare Rules Aim to Reduce Suspicious Billing Abuse

Dec 06, 2014
Announced in the Wall Street Journal on Dec 3, 2014, the Obama administration has strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government.

Second quarter PQRS interim claims feedback data available

Nov 27, 2014
Eligible professionals (EPs) who reported at least one PQRS quality measure during 2014 via claims-based reporting can access their data on a quarterly basis using the 2014 PQRS Interim Feedback Dashboard. The dashboard allows EPs to monitor the status of claims-based individual measures reporting to determine if they are meeting PQRS requirements.

The dashboard allows EPs to monitor the status of claims-based individual measures reporting to determine if they are meeting PQRS requirements.

Radiology Billing Company To Pay $1.95 Million To Resolve False Claims Act Allegations

Oct 16, 2014
MBS), which agreed to pay $1.95 million to settle claims that it violated the False Claims Act by fraudulently changing diagnosis codes on claims to Medicare and Medicaid, in order to get the rejected claims paid on behalf of radiologists.

New meaningful use rule: MGMA and CMS offer resources

Sep 20, 2014
Centers for Medicare & Medicaid Services (CMS) recently finalized a rule which expands reporting options for the meaningful use EHR Incentive Program in 2014.

Physical Therapy Providers - The OIG Might Want to Look at Your Records Too

Sep 20, 2014
Lynn Berry, PT, CPCPT, suggests that physical therapy (PT) providers should go to the website, put in their NPI numbers or names, and see where their Medicare billing stood in relation to other providers.

Be Prepared for the X Factor - 4 New HCPCS Modifiers Effective Jan 1, 2015.

Sep 07, 2014
In an effort to reduce inappropriate claim payments due to incorrect use of modifier 59, The Centers for Medicare and Medicaid Services (CMS) will roll out four new HCPCS modifiers to describe specific circumstances when it is appropriate to override a CCI edit. These -X modifiers become effective on January 1, 2015.

CMS Changes to the Use of Modifier -59

Aug 26, 2014
CMS is establishing four new HCPCS modifiers to define subsets ofthe - 59 modifier, a modifier used to define a "Distinct Procedural Service."

AMA Forecasts Over 500 Changes to the 2015 CPT Code System.

Aug 26, 2014
The AMA states that there are over 500 changes to the 2015 CPT code system.

Medicare Fraud Hard to Stop, But Predictive Analytics Technology Helping

Aug 16, 2014
Medicare says its new high tech predictive analytics system “is successfully doing its job of pointing the spotlight on bad behavior and prioritizing the most egregious situations for investigation.”

Increased Audits of E&M Services by CMS - Recommendations from OIG

Jun 19, 2014
In May of 2014, the Office of the Inspector General (OIG) released a report detailing its findings regarding Medicare payments for evaluation and management (E/M) services. E/M services are performed by physicians in order to assess and manage a beneficiary's health.