Medicare Billing Rises at Hospitals With Electronic Records

The New York Times published an article: "Medicare Billing Rises at Hospitals With Electronic Records". The article discussed many key points on the impact of Electronic Health Records (or EHRs). The following are some points from the article:

• EHRs may be contributing to billions of dollars in higher costs for Medicare, private insurers & patients making it easier for the physicians to bill more for their services.
• In 2010, hospitals received $1 billion more in Medicare reimbursements than 5 years prior.
• For instance one hospital's reimbursements rose 43% in 2009, the same year they began their EHR.
• Another hospital discussed in the article had an increase in their paid claims by 82%.
• Because of the higher coding, this has prompted the attention of federal & state regulators as well as private insurers - they state that coding of E/M Services is vulnerable to fraud and abuse.
• One individual stated that  EHRs "can improve the quality of care, save lives and save money"

Some negatives of Electronic Health Records - EHRs are as follows:

• Automatically generated patient history
• Cut-and-paste examination findings from multiple patients - called "cloning"
• Boxes that allow doctors to review patients symptoms without a full exam being done.
• One individual was quoted stating: (the use of electronic records): "makes it faster and easier to fraudulent".

To download the full article, please click the following link: "Medicare Billing Rises at Hospitals With Electronic Records"

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement, Inc. Resources Page

How to Use The National Correct Coding Initiative (NCCI) Tools

Are you familiar with the NCCI (National Correct Coding Initiative) and how to tell if your coding is up to par?

The guide, "How to Use The National Correct Coding Initiative (NCCI) Tools" Produced by the Centers for Medicare and Medicaid Services highlights the following topics:

• What is the National Correct Coding Initiative (NCCI)
• Who should use the NCCI Web Page, Tables, and Manual
• How Up-to-Date are the NCCI Tables
• Background: NCCI Edits
• Using The NCCI Tools 
• Looking Up 2 Types of Code Pair Edits  
• How to Use the Code Pair Tables 
• Looking up the 3 Provider-Types of Medically Unlikely Edits (MUEs)
• Using the NCCI Policy Manual For Medicare Services
• Resources page with additional websites
• How to Filter NCCI data tables

To download and view the full guide, please go to the following link: NCCI Tools

Avoid Receiving Improper Payments Before and After Processing Your Claims

Do you know how to avoid receiving improper payments before & after processing your claims?

A how-to guide on Medicare Claim Review Programs was produced by The Centers for Medicare and Medicaid and highlights the following topics:

• Medicare Contractors and Their Responsibilities
• Medicare Prepayment and Postpayment Claim Review Programs
• National Correct Coding Initiatives (NCCI) Edits
• Performed by Affiliated Contractors (ACs) /Medicare Administrative Contractors (MACs)
• Medically Unlikely Edits (MUEs)
• Performed by ACs/MACs
•  FAQs on Medically Unlikely Edits
• AC/MAC MR Program performed by ACs/MACs
• Comprehensive Error Rate Testing (CERT) Program
•  Performed by CERT RC and CERT DC
•  CERT Error Rates
• Recovery Audit Program performed by Medicare FFS Recovery Auditors
• Summary of MR (AC/MAC Medical Review), NCCI Edits, MUEs, CERT, and Recovery Audit Program
• Supplementary website resources with more information on Medicare Claim Review Programs

To download and view the full fact guide, please go to the following link: Medicare Claim Review Program

The Medicare Overpayment Collection Process

Need guidelines on The Medicare Overpayment Collection Process?

The Centers for Medicare and Medicaid Services (CMS) produced a short fact sheet on "The Medicare Overpayment Collection Process" in July 2011.

According to the CMS, The definition of a Medicare Physician or Supplier Overpayment is:

"A payment that a physician or supplier has received in excess of amounts due and payable under Medicare statute and regulations. Once a determination of an overpayment has been made, the amount of the overpayment becomes a debt owed by the debtor to the Federal government. Federal law requires the Centers for Medicare & Medicaid Services (CMS) to seek the recovery of all identified overpayments."

In Medicare, physician or supplier overpayments occur due to: 

• Duplicate submission of the same service or claim;
• Payment to the incorrect payee;
• Payment for excluded or medically unnecessary services; or
• A pattern of furnishing and billing for excessive or non-covered services.

The Overpayment Collection Process

• Demand Letters
• Repayment Plans
• Rebuttals
• Appeals

Additionally there are links to external websites regarding Medicare Overpayments and the collection process.

To download and view the full fact sheet, please go to the following link: The Medicare Overpayment Collection Process Fact Sheet