Articles, tagged with "centers for medicare and medicaid", page 4

ICD 9 codes effective Oct 1 fewer in number than previous years

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 Smith

Get on top of the latest HCPCS codes to maximize reimbursements

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 Smith

Paying for Health Care Reform with Medicare/Medicaid Savings

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 Bigman

Change in NAIC Standards for Medigap Insurance

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 Long

Carriers Dropping Medicare Advantage Private Fee-for-Service Plans

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 Long

Top Carriers Dropping Medicare Advantage Private Fee-for-Service Plans

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 Long

Correct Coding Initiative works towards averting improper payment

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 Smith

Medicare Eases Rule on Termination of Provider Medical Records Review

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 & Associates

Medicare’s Anti-Markup Rule-Partially Delayed Until 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 a... Read >
Author: Wachler & Associates

CMS Finalizes Major Stark Changes

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 modifications to ... Read >
Author: Wachler & Associates

Medicare’s Physician Quality Reporting Initiative: The New Frontier on Pay for Performance

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 Initiative, whic... Read >
Author: Wachler & Associates

Stark II Phase III

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 & Associates

The Medicare Appeals Process and Strategies for Successful Appeals

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 & Associates

The RACs Are Coming -- Are You Ready?

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 their legal cou... Read >
Author: Wachler & Associates

The 2009 Medicare Physician Fee Schedule: The Anti-Markup Rule and IDTF Developments Impacting Diag

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 diagnostic ... Read >
Author: Wachler & Associates

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