Final Rule on Returning Overpayments

On February 11, 2016, CMS published a final rule (CMS 6037-F) requiring providers and suppliers to return an overpayment within sixty days of identifying it. The consequences for not returning an overpayment within this time frame could include potential False Claims Act liability, Civil Monetary Penalties Law liability, and exclusion from federal health care programs.…

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Reading the glaucoma reimbursement tea leaves – Ophthalmology Management

This month we will review trends in glaucoma reimbursement — past and future — in the larger context of eye care. In the United States, the most common eye diseases are age-related macular degeneration, cataract, glaucoma and diabetic retinopathy. As baby boomers age, their demands for healthcare and eye care will grow. Some ocular conditions…

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2016 Medicare Deductible and Premiums

CMS published a news release November 10, 2015, announcing Medicare premiums and deductibles for 2016. The 2016 Medicare Part B deductible is $166, which is a $19 increase from 2015. This is the first increase since 2013. With no Social Security cost of living increase in 2016, most Medicare beneficiaries will continue to pay premiums…

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Medicare Card Revisions

When a practice seeks social security numbers from patients, they often find patients hesitant to provide this information for fear of identity theft.  Yet, if the patient is a Medicare beneficiary, their social security number is printed on their card for all to see.  This has been highly scrutinized for years by security experts concerned…

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2015 Medicare Claims to be Placed on Temporary Hold

All Medicare Administrative Contractors (MAC) have removed the originally-posted 2015 Calendar Year (CY) Medicare fee schedules from their websites.  Some MACs have already posted that claims processing will be delayed 14 days “due to technical errors” found in the release of the original fee schedule. Noridian’s website on this subject contains the following information: In…

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2014 Physician Quality Reporting System – Review of Ophthalmology

National Quality Domains, Qualified Clinical Data Registry options and other changes you should know about. This article answers the following questions: Does the Physician Quality Reporting System continue in 2014? Is there still an opportunity to receive a bonus for participating? Are the requirements for successful participation in 2104 different than in prior years? What…

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ICD-10 Testing with Medicare MACs

It appears that CMS has had a change of heart regarding testing your ability to transmit claims with ICD-10 codes prior to the October 1, 2014 implementation date.  Previous comments by CMS indicated that no testing would occur.  However, MLN Matters Number MM8465 announces a testing week slated March 3-7, 2014.  The purpose of the…

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Refractions: Questions on the most common test – Ophthalmology Management

Refraction is the single most common diagnostic test in eye care. Still, questions arise about it. This article answers the following questions: When may we charge for refraction? Must we dispense an Rx for eyeglasses? What is Medicare’s policy concerning refractions? Must I include refractions on claims for Medicare beneficiaries? Are refractions ever considered part…

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Denied Claims Set for Reprocessing

The NCCI edits effective July 1, 2013, which bundled most exams with minor and major surgical procedures, have caused numerous claim denials.  Many Medicare contractors published an acknowledgment of the problem on their websites that read as follows.  “Changes to the July 2013 NCCI edits for Evaluation and Management (E/M) codes, including Eye Examination codes…

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A Beginner’s Guide to Medicare

Regardless of who handles the red tape of billing and coding in your practice, your understanding of Medicare requirements will ensure the practice is being paid appropriately.

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