tci Medicare Compliance & Reimbursement - 2016 Issue 20

Compliance: Billing Blunders Got You in a Bind?

As the Medicare system evolves, billing continues to be a source of consternation for providers, suppliers, patients, MACs, and CMS. Code and fee changes, documentation standards, LCD and NCD updates, HIPAA and compliance regulation worries—the list of things that must be in line for a claim to be processed correctly and paid seems endless. Unfortunately, the confusion that plagues the Medicare claims process often leads to denied claims and improper payments. Though CMS has seen a marked decline in its improper payment rate with provider outreach efforts now securely in place, the 2015 CERT findings clearly show that...

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