Telerheumatology—which refers to the application of electronic communication technology to clinical encounters from a distance between rheumatologists and their patients—has the potential to extend a workforce projected to experience significant shortfalls, making it more accessible to more patients. Multiple barriers that stood in the way of taking full advantage of this promise are now down—at…
As the number of COVID-19 cases continues to rise in the U.S., the fast spread of the virus is causing gaps in practice staffing, and patient influx will likely increase, leaving systems needing more providers. The use of locum tenens physicians can help practice fill gaps at your organization caused by COVID-19. Below we offer…
The Medicare statute states that items and services provided to beneficiaries must be “reasonable and necessary” to qualify for reimbursement. Although the Medicare program determines in specific cases whether an item or service is reasonable and necessary, it also issues policies, called coverage determinations, to instruct Medicare Administrative Contractors (MACs) what to reimburse providers for….
The Stark law and the Anti-Kickback Statute (AKS) are the U.S. healthcare system’s primary fraud and abuse laws, and highly anticipated proposed reform plans from the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) were finally unveiled on Oct. 17, 2019. The proposed reforms would 1) clarify certain requirements…
ATLANTA—In a session at the 2019 ACR/ARP Annual Meeting, Susan Chrostowski, DNP, assistant clinical professor at Texas Woman’s University College of Nursing, Dallas, told the audience that she’d had a visit with a patient and asked how he was doing. “Not too good,” he said, explaining that his chest hurt. “What’s the matter with your…
On behalf of the ACR, I wish you happiness, prosperity and, above all, good health in this new decade. Now that the holidays are behind us and 2020 has launched, the ACR’s dedicated volunteers and staff are working collaboratively to achieve many ambitious initiatives to ensure the College’s dynamic and bright future. A few weeks…
Although the Centers for Medicare & Medicaid Services (CMS) is simplifying documentation through its Patients over Paperwork initiative, clinical documentation improvement (CDI) did not go away. CDI is not about how to code in ICD-10-CM or the Current Procedural Terminology (CPT); instead, it is a huge part of the solution in maximizing the integrity of…
Take the challenge. 1. A—Internet-only manuals Before appealing the request for an overpayment or appealing a denial, providers and staff should first verify the claim was coded and billed correctly. Second, staff should review the internet-only manuals website, which includes operating instructions, policies and procedures that cover CMS policies based on statutes, regulations, guidelines, models…
A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request? Internet-only manuals National Correct Coding Initiative Medically Unlikely…
Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…