January 2017 Client Newsletter
2017 Medicare Deductible
CMS announced on 11/10/16 that the Medicare Part B deductible will be $183, compared to $166 for 2016.
Ambulance Audit Guidance
Cape Medical Billing was privileged to be asked to review a Medicare audit by a non-CMB client. On December 8, 2016, all Cape Medical Billing EMS clients received a summarized document discussing the results of that audit to understand how Medicare views Run Report documentation. CMS made it clear that even if the call is via the 911 system, if it really ends up being a Non-emergency transport - then it needs to be billed that way. They were also very specific that it not be billed as emergency if the pt. does not meet the clinical criteria (Medicare post-payment denied the claim and retracted the payment).
Medicare is NOT saying you cannot transport such patients - they just do not qualify for Medicare payment. Call Rich if you wish to discuss further.
Insurance Refund Requests
Just a reminder that if we receive ANY refund requests from an insurer (except Medicare, RRMC, TriCare or Medicaid) that are more the 18 months since the payment date (the NJ legal limit) - that refund needs to be reviewed by Cape Medical Billing before sending a refund. Absent fraud, we can likely legally argue it is beyond the legal limit to request it.
Medicare EHR Attestation
In case you have not seen it anywhere else from CMS...
"Review the 2016 Medicare EHR Incentive Program Requirements
In 2016, the EHR reporting period is a minimum of any continuous 90 days between January 1, 2016 and December 31, 2016. There is also a 90-day reporting period for CQMs for providers that choose to report CQMs by attestation.
The EHR Incentive Programs attestation system will be open from January 3, 2017 to February 28, 2017. Providers must attest by the attestation deadline to avoid a 2018 payment adjustment.
In preparation for attestation, CMS encourages providers to review the 2016 program requirements webpage on the EHR Incentive Programs website."
OIG Releases 2017 Work Plan
The Department of Health and Human Services Office of Inspector General (OIG) released its FY 2017 Work Plan, which describes OIG audits evaluations, and certain legal and investigative initiatives that are new or ongoing in FY 2017. According to the work plan, in FY 2017 and beyond, Among other items for providers, OIG will focus on Medicare payments for:
- Transitional Care Management
- Chronic Care Management
- Sleep Disorder codes 95810 & 95811
- Physician Home Visits
- Prolonged Services
- Power Mobility Devices
- Ambulance Services
A copy of the Work Plan objectives was emailed to each client based on their specialty.
Medicare G0179 & G0180
Just a reminder that billing these two codes requires at least 60 days from the previous date. Billing sooner results in payment denial.