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16th September 2009
Effective January 1, 2007, the Centers for Medicare and Medicaid Services (CMS) implemented Medically Unlikely Edits (MUEs) to reduce the Paid Claims Error Rate for Part B claims. These edits are designed to minimize errors that occur due to clerical entr... Read >
Author: angela16th September 2009
An acronym for International Classification of Diseases, ICD-9 is a numeric diagnostic code used by insurance companies to determine whether to pay for a medical test, treatment or procedure. The 9th edition is the most recent one, with ICD 10 slated for ... Read >
Author: James Smith16th September 2009
Acronym for Healthcare Common Procedure Coding System, HCPCS was developed by Centers for Medicare and Medicaid Services (CMS) as a way to standardize identification of medical services, supplies and equipment.
Commonly known as hick-picks, these HCPC... Read >
Author: James Smith02nd September 2009
For the past several years, the US government together with its people has been struggling to keep up with the continuous rise in the costs of healthcare. Last 2007, according to the Centers for Medicare and Medicaid Services, Office of the Actuary, Nati... Read >
Author: callcare30th August 2009
For the past several years, the US government together with its people has been struggling to keep up with the continuous rise in the costs of healthcare. Last 2007, according to the Centers for Medicare and Medicaid Services, Office of the Actuary, Nati... Read >
Author: callcare20th August 2009
Here in Asheville North Carolina, health insurance reform is a huge issue as our local population consists largely of retirees, many of whom are becoming increasingly concerned about the cost sustainability of their Medicare and their North Carolina healt... Read >
Author: Elliot Bigman19th August 2009
The federal government has adopted new standards for Medicare supplement insurance. The standards were developed by the National Association of Insurance Commissioners (NAIC) and were set by the Centers for Medicare and Medicaid Services in order to apply... Read >
Author: Wiley Long16th August 2009
Top health insurance carriers are dumping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that i... Read >
Author: Wiley Long16th August 2009
Top health insurance carriers are dropping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that ... Read >
Author: Wiley Long08th August 2009
The National Correct Coding Initiative (NCCI) was developed by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and to control inappropriate coding leading to incorrect payment. The CMS (then the Health... Read >
Author: James Smith09th July 2009
Medicare providers and suppliers targeted for prepayment complex medical review understand the financial burden that review of records prior to payment places on a medical practice.
Prior to the Medicare Prescription Drug, Improvement and Modernization... Read >
Author: Wachler & Associates09th July 2009
On December 28, 2007, the Centers for Medicare and Medicaid Services (CMS) displayed a final rule announcing that it was delaying the effective date of the majority of the newly revised anti-markup rule until January 1, 2009. CMS’ announcement came just... Read >
Author: Wachler & Associates09th July 2009
On August 19, 2008, the Centers for Medicare and Medicaid Services (“CMS”) published final Stark rules in its 2009 Final Hospital Inpatient Prospective Payment Systems Rule
(“Final Rule”). The Final Rule contains several significant modificat... Read >
Author: Wachler & Associates09th July 2009
Recently, the Centers for Medicare and Medicaid (“CMS”) entered into the pay for performance arena with the Physician Quality Reporting Initiative (“PQRI” or “Initiative”) aimed at improving the quality of health care. Participants in the Ini... Read >
Author: Wachler & Associates08th July 2009
The long-awaited third and final phase of the rulemaking that amends the Stark regulations (Stark) was released by the Centers for Medicare and Medicaid Services (CMS) on August 27, 2007. The phase III final rule (Phase III) will be effective December 4... Read >
Author: Wachler & Associates08th July 2009
Introduction
The Centers for Medicare and Medicaid Services (CMS) issued its final rule regarding changes to the Medicare appeal procedures on March 5, 2005. This final rule was effective May 1, 2005. Legal counsel for providers and suppliers underg... Read >
Author: Wachler & Associates07th July 2009
I. INTRODUCTION
The Centers for Medicare and Medicaid Services (“CMS” or “Medicare”) Recovery Audit Contractor (“RAC”) program has been made permanent and is expanding nationwide, beginning this year. Medicare providers, suppliers and the... Read >
Author: Wachler & Associates06th July 2009
In recent years, the Centers for Medicare and Medicaid Services (“CMS”) has heavily scrutinized the terms and conditions under which Medicare will pay for diagnostic testing services, resulting in heightened regulatory action targeting certain diagnos... Read >
Author: Wachler & Associates06th July 2009
Physicians, providers and suppliers providing services under Part A of Medicare, who have been subject to Medicare audits or claim denials resulting in overpayment demands, are aware that, currently if a Medicare fiscal intermediary identifies an alleged ... Read >
Author: Wachler & Associates06th July 2009
I. INTRODUCTION
Attention radiology providers and suppliers: Get ready for increased Medicare auditing activity. The Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nat... Read >
Author: Wachler & Associates10th June 2009
HCPCS Codes, Healthcare Common Procedure Coding System numbers, are the medical codes used by Medicare. The HCPCS is monitored by CMS, the Centers for Medicare and Medicaid Services. Developed by the AMA or the American Medical Association, the codes are ... Read >
Author: Nancy05th June 2009
The Federal Stark law prohibits physicians from referring Medicare/Medicaid beneficiaries to an entity in which they (or an immediate family member) have a financial relationship for designated health services (“DHS”), unless an exception applies. DH... Read >
Author: Wachler & Associates05th June 2009
On August 19, 2008, the Centers for Medicare and Medicaid Services (“CMS”) published final Stark rules in its 2009 Final Hospital Inpatient Prospective Payment Systems rule (“Final Rule”). The Final Rule contains several important revisions to th... Read >
Author: Wachler & Associates05th June 2009
Recently, the Centers for Medicare and Medicaid (“CMS”) entered into the pay for performance arena with the Physician Quality Reporting Initiative (“PQRI” or “Initiative”) aimed at improving the quality of health care. Participants in the Ini... Read >
Author: Wachler & Associates05th June 2009
On December 28, 2007, the Centers for Medicare and Medicaid Services (CMS) displayed a final rule announcing that it was delaying the effective date of the majority of the newly revised anti-markup rule until January 1, 2009. CMS’ announcement came just... Read >
Author: Wachler & Associates05th June 2009
In recent years, diagnostic imaging services have been intensively scrutinized by the federal government. This article will summarize some of the more significant recent federal regulatory changes included in the 2009 Medicare Final Physician Fee Schedul... Read >
Author: Wachler & Associates14th May 2009
Medicare is a social insurance program administered by the United States government. It is set up as a single payer health care system which means that all service providers such as doctors, labs, hospitals, therapists etc, get paid from one central fun... Read >
Author: Empowering Information10th April 2009
Before individual state governments passed much-needed legislation, many assisted living facilities were only private pay situations. Fortunately, for many older Americans facing housing dilemmas, Medicaid waiver programs have taken up much of the slack t... Read >
Author: Jill Gilbert21st July 2008
The Medicare program is one of the health insurance programs of the federal government for the elderly and disabled. It is administered by the Centers for Medicare and Medicaid Services (CMS).
Under the law, the program provides benefits for the follo... Read >
Author: Mesriani Law Group22nd January 2008
Basic Facts Of The Medicare Program
President Johnson In 1965 enacted Medicare for seniors to have the opportunity to obtain affordable healthcare. There have been many improvements over the years.
The Centers for Medicare and Medicaid Services... Read >
Author: Mr King19th June 2007
Due to highly questionable sales tactics and reports of outright fraud, seven major health insurers have agreed to suspend marketing for a certain form of Medicare policy.
Well known companies including Humana, the WellCare Group, and UnitedHealth Gr... Read >
Author: Cathlene Martinez08th June 2007
When you reach the age of 65 or become disabled, you are eligible for Medicare, but when are you eligible for Medicaid? Medicaid eligibility, unlike Medicare’s, is not automatic.
Medicaid is a government funded health insurance program like Medicare... Read >
Author: Barry Waxler08th June 2007
As a person nears retirement age, they begin to wonder if they are eligible for Medicare. Many people do not realize that they may even be eligible for Medicare before the age of 65.
Medicare is the largest health insurance plan in the United States. I... Read >
Author: Barry Waxler14th March 2007
There is no need to stress how important healthcare is for children. To add to this, in the US, there is no federal or state blanket medical coverage for children.
Parents usually get coverage for their children’s health by their individual or hob-ba... Read >
Author: AdamHeist23rd June 2006
A recent study shows that the aging of baby boomers will do more than merely increase the number of patients it also will reduce the number of doctors and nurses available to care for them.
Nearly 13% of registered nurses in the U.S. will reach retirem... Read >
Author: John Knab21st June 2006
A recent study shows that the aging of baby boomers will do more than merely increase the number of patients it also will reduce the number of doctors and nurses available to care for them.
Nearly 13% of registered nurses in the U.S. will reach retirem... Read >
Author: John Knab
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