Billing for venom testing and immunotherapy
As we noted in last week’s Insider, there continues to be concerns about pricing and adequate availability of venoms for testing and treatment. We also u…
How many MUE’s can be billed in a day?
Both Medicare and Medicaid have national “medically unlikely edits” (MUEs) in place that are designed to automatically deny claims that exceed specific daily l…
Recovery Audit Contractors (RACS) – What’s new?
In this third and final article in the series, the Advocacy Council addresses the activities of Medicare’s Recovery Audit Contractors (RACs). RACs …
Recovery Audit Contractors (RACS) – What’s new?
In this third and final article in the series, the Advocacy Council addresses the activities of Medicare’s Recovery Audit Contractors (RACs). RACs …
Streamlined audit and fraud program
In this second of our three-part series on the Center for Medicare and Medicaid Services’ (CMS) audit and fraud programs, the Advocacy Council (AC) focus…
Confused by the Medicare audit and fraud programs?
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Change is coming to United Health Care
The Advocacy Council has learned that beginning October 1, 2017, United Health Care (UHC) will stop paying for physician visits billed under certain inpatient …
21st Century Cures – in-depth
On Nov. 30, the House of Representatives passed the 21st Century Cures Act by a vote of 392-26. The bill now goes to the Senate where it is expected to receive…
New modification to the “two midnight” rule
Currently, you cannot admit a Medicare patient to an intensive care unit for desensitization to a chemotherapeutic agent or antibiotic because you need to cert…
Sorting out modifier -59 changes
Modifier -59 is not only the most used modifier, but it’s also one of the most abused. Modifier -59 is used to indicate that a procedure or service was distinc…
