decisionhealth Newsletters, Part B News - 2017 Issue 10 (October)
2 tips for busy practices to keep up with Medicare’s reimbursement rules
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Article Overview
This article is aimed at medical coders, billing staff, and practice managers who need to monitor Medicare updates that can affect claims processing, reimbursement, and audit support. It discusses how to interpret quarterly CMS file changes, compare online coding tools with official Medicare sources, and recognize when edit files or fee schedule updates have changed. The guidance is centered on staying current with Medicare’s published files and using them to verify claim-related information.
Why This Topic Matters
Medicare reimbursement and edit files change over time, and outdated references can lead to denials, missed payment opportunities, or audit problems. Understanding how to check official CMS files helps practices confirm current information and document support for billing decisions.
Article Sections
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Check the latest RVU file updates for changes
This section focuses on how physician fee schedule file updates can differ from older references and why quarterly CMS updates matter for claim review. It centers on monitoring changes in Medicare fee schedule data and related implementation timing.
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Watch fifth column activity in CCI edits file
This section discusses how to review Correct Coding Initiative edit files, including deleted or changed entries that remain in the file history. It also addresses using CMS summary resources and retaining update files for audit support.
What You Will Learn
- How Medicare file updates can affect reimbursement references
- How to compare official CMS resources with third-party coding tools
- How quarterly update timing affects claim review and follow-up
- How to recognize changes in Correct Coding Initiative edit files
- How to use CMS files as supporting documentation during audits
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Revenue cycle personnel
Codes Discussed
Modifiers Discussed
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