CMS Releases 2020 Medicare Advantage Final Rule

On April 5, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations for calendar year 2020. In this final rule, CMS is implementing several sections of the Bipartisan Budget Act of 2018. One of the…

CMS Releases FY2020 SNF Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has released the Skilled Nursing Facility (SNF) fiscal year (FY) 2020 proposed rule. CMS has published a fact sheet that highlights 3 major provisions of the proposed rule that are: The proposed changes to SNF payment policy under the SNF Prospective Payment System (PPS) The SNF Value-Based…

CMS Releases IRF FY 2020 Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2020 Inpatient Rehabilitation Facility (IRF) proposed rule. Highlights of the proposed rule include: CMS projects that IRF payments will increase by 2.3 percent for FY 2020 Revising the case-mix groups based on two years of data (FY 2017 and FY 2018)…

Targeted Probe and Educate: What Is It?

As many of you have found out the hard way, the Centers for Medicare and Medicaid Services (CMS) implemented a new program called Targeted Probe and Educate (TPE) where the goal of the program is to help providers and suppliers reduce claim denials and appeals through one-on-one education. CMS uses data analysis to identify providers…

When Can I Bill for a Reevaluation

I receive many questions concerning when is it appropriate to bill for a reevaluation to an insurance carrier. A few of the questions I receive are: Can I bill for a reevaluation for when I’m required to complete a Progress Report on a Medicare patient or for that matter, any patient? Can I bill for…

WPS Upcoming SNF Webinars

Wisconsin Physician Services (WPS) has several webinars upcoming for the skilled nursing facility (SNF setting. Upcoming webinars include, but are not limited to: SNF Coverage Requirements & Admission Procedures SNF Billing Basics, Adjustments, & Cancellations SNF Benefits Exhaust & No-Pay Billing SNF Billing Beyond the Basics SNF Consolidated Billing (Part 1) SNF Consolidated Billing (Part…

Changes Coming To Usage of Modifier 59

The Centers for Medicare and Medicaid Services (CMS) has announced a significant change to the use of modifier 59, XE, XP, XS and XU effective July 1, 2019. Currently, the multi-carrier system (MCS) claims system processing logic for modifier 59, XE, XP, XS and XU be appended to the column two CPT code of a…

CMS National Correct Coding Initiative (NCCI) Medicare and Medicaid Program Announcement

CMS would like to announce that on February 1, 2019, the National Correct Coding Initiative (NCCI) Medicare and Medicaid Program Contract was awarded to a new contractor, Capitol Bridge LLC (2300 9TH STREET, SOUTH, PH3 ARLINGTON, VA 22204 Congressional District: VA-08). The incumbent contractor, CCS WP LLC/Correct Coding Solutions LLC and its principles will be…

Denials for Canalith Repositioning (CPT Code 95992)

I have been receiving emails from some of my followers regarding their Medicare Administrative Contractor (MAC) not paying for CPT code 95992 – Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day. This CPT code came out in 2009 and the Centers for Medicare and Medicaid Services (CMS) made this a payable CPT code…

Anthem Delays Implementation of New Utilization Management Program

Anthem BC has announced its delayed implementation of AIM for the state of California. The AIM Utilization Management program will not go live on March 25, 2019. The new implementation date will be communicated once it becomes available.