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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Articles tagged with "Centers for Medicare & Medicaid Services (CMS)"

Working With Your National Provider Number

Melesia Tillman, CCP, CPC  |  

Beginning May 23, 2008, all practicing physicians who treat Medicare patients must start billing with a working national provider identifier (NPI). Physician and non-physician providers can make any corrections or changes pertaining to their NPIs by contacting the National Plan and Provider Enumeration System (NPPES)…

American College of Rheumatology (ACR) on Capitol Hill

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“By tomorrow night, there will be so many more people on Capitol Hill who know—and are sensitive to—rheumatology and the issues that impact you and your patients. There is no substitute for what you are doing,” says Martha M. Kendrick, a partner at Patton Boggs, LLP, the ACR’s lobbying firm. This is what she told the physician, health professional, and patient participants of the ACR’s 2008 “Advocates for Arthritis” advocacy event—termed a fly-in—before they took their personal stories to the lawmakers on Capitol Hill.

How Medically Unlikely Edits Affect a Practice

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Medically unlikely edits (MUEs), formally known as medically unbelievable edits, took effect with the Centers for Medicare & Medicaid Services (CMS) on January 2, 2007. The function of MUEs is to detect and deny unlikely CMS claims on a pre-payment basis with the intention of improving Medicare’s payment process.

Clean Claims Equal Prompt Payment

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Submitting a clean Medicare reimbursement claim the first time can save your practice thousands of dollars each year. The Centers for Medicare and Medicaid Services (CMS) defines a clean claim as “a submitted patient claim form without any defect or need for substantiation.”

Fraud and Abuse: What’s the Difference?

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Each year, fraud and abuse cost the Medicare and Medicaid programs billions of dollars. What is the difference between fraud and abuse? The Centers for Medicare & Medicaid Services define fraud and abuse as two different offenses…

Be Aware of New Waived Tests

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Keeping current on changes to laboratory certifications for common lab tests can save your practice time—and money. Since the passage of the Clinical Laboratory Improvement Amendments (CLIA) in 1988, all health-assessment laboratory tests are ranked for complexity, and their complexity dictates which labs can process Centers for Medicare and Medicaid Services (CMS)–reimbursed tests. In accordance with CLIA, each laboratory facility must register with CMS to receive a CLIA certification. There are five certifications, each with differing degrees of complexity, listed from least to most complex: Certificate of Waiver, Certificate of Provider-Performed Microscopy Procedures, Certificate of Registration, Certificate of Compliance, and the Certificate of Accreditation.