Providers also should develop compliance policies to address any identified risk areas. Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDS, Richard “Dick” Beckley, YNS, USN, 1966-1970, Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P. Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC and David Glaser, Esq. JUser: :_load: Unable to load user with ID: 10396. Graphic presentations contained in these reports help to communicate a provider's billing pattern more clearly. Use your data to support internal auditing and monitoring activities. Establishing an Infection Prevention Program in a Nursing Home, With an Emphasis on COVID-19. Recipients of a CBR and provider types that have been tabbed to receive the reports should consider contacting a health law attorney to discuss CBR analysis and development of an appropriate compliance plan that will reduce audit risks going forward.
Ms. Fehn is a former registered nurse who has been counseling healthcare providers for the past eleven years on regulatory and compliance matters and frequently defends providers in RAC and other Medicare audits. Medicaid Services. This newsletter is current as of the issue date. Providers who recently received a comparative billing report (CBR) or have heard about the release of these reports may be asking how CBRs fit into the current audit landscape. Copyright © 2020 | RACmonitor.com, a division of MedLearn Media, Inc. There is an opportunity to ask questions. a difference in patient population). The provider types that thus far have been tabbed to receive the reports include chiropractors, ambulance services, hospice, podiatry, sleep studies and spinal orthotics, each having its own vulnerabilities identified by CMS. Also, in our experience the vulnerabilities identified in the CBRs tend to be the same as those identified by CMS contractors who select providers for audit. and Emma E. Trivax, Andrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADV. Shannon Deconda, CPC, CPC-I, CEMC, CMSCS, CPMA®, Stefani Daniels, MSN, RN, CMAC, ACM and Tiffany Ferguson, LMSW, ACM, Stephanie Van Zandt, MD, FACOG, CHCCQM-PHYADV, Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC. Medicare Administrative Contractors (MACs) produce comparative billing reports for providers in their jurisdiction to educate their providers about vulnerable areas in the Medicare program. A new MLN Matters Article MM11889 on Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2020 (PDF) is available. Target Audience: Physicians and other clinicians. Graphic presentations contained in these reports help to communicate a provider's billing pattern more clearly. CBRs: A Comparative Billing Report (CBR) provides comparative billing data to an individual health care provider.
The reports do not include patient or case-specific data, only summary billing information, this being a method of ensuring privacy. Learn about payment allowances, effective August 1. A maximum of 5,000 providers in each provider class will be selected to receive CBRs.
The PEPPER files were recently distributed through a QualityNet secure file exchange to hospital QualityNet Administrators and user accounts with the PEPPER recipient role. MLN Matters Article MM11699 on Claim Status Category Codes and Claim Status Codes Update (PDF) is rescinded. CMS issued a Comparative Billing Report (CBR) on Lower Extremity Joint Replacement, focusing on providers who submit Medicare Part B claims.
Consistent with Sections 1833(e), 1842(a)(2)(B), and 1862(a)(1) of the Social Security Act, the Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Funds against inappropriate payments that pose the greatest risk, and take the proper corrective actions. Learn about new and revised pricing files.
Have suggestions? Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, Elizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADV, Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP, Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM, Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainer, Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer. Thus, providers who are identified as outliers in CBRs likely will be subject to audits.
Since then CMS has expanded the number of provider types slated to receive CBRs. These calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration (FDA) Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Nursing Homes & COVID: Five Things to Know, Additional Resources, Training, Deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force, Implement an enhanced survey process tailored to meet the specific concerns of hotspot areas and coordinate federal, state, and local efforts to leverage all available resources to these facilities, CBRs are not publicly available.