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

Coding Corner Questions: Navigating Medicare’s Online Resources

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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…

How to Navigate & Manage Insurance Overpayments

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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…

Coding Corner Answer: Interprofessional Consultations

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Take the challenge. Answer: This is a two-part office visit scenario. The first part of the scenario illustrates the original new patient office visit, and the second portion is for the follow-up, interprofessional telephone consultation with the patient’s ophthalmologist. For the office visit … CPT: 99203 ICD-10: B30.8, M45.5, I73.00 The history was detailed, because…

Coding Corner Question: Interprofessional Consultations

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A 68-year-old patient reports that her eyes have been itchy and red for approximately one month. She was treated with erythromycin gel on Jan. 10; while the itching did not stop, the redness resolved. She denies any matting and has not used any other type of eye drops. She states there has been no change…

The ACR Maps the Future of the RISE Registry

Paula Marchetta, MD, MBA  |  

In the first scene of the Broadway stage adaptation of Harper Lee’s To Kill a Mockingbird, young Scout contemplates two words she has heard in the courtroom: “All rise,” and wonders if they really are meant to elevate the minds of all those present for the proceedings. That instruction—“All rise”—serves as a leitmotif throughout the…

CMS Now Conducting 2017 & 2018 MIPS Data Validation Audit

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CMS has begun data validation and audit for 2017 and 2018 MIPS performance years. Providers/practices selected for the audit will be notified via certified mail or email and will have 45 days from the date of notice to provide the requested information. For more information regarding the data validation criteria, visit the CMS Resource Library….

Advocacy Leads to Legislator Access

Paula Marchetta, MD, MBA  |  

We have often heard it said that opportunity arises from challenges. Challenge, of course, is really just a polite way of saying problem—and for our patients, problems abound when it comes to obtaining timely and affordable access to the rheumatologic care they need. Access in this context has many meanings: There is access to life-changing…