Awareness : Newsletter Articles

Medicare Overpayments

A Medicare overpayment is a payment you receive in excess of amounts properly payable under Medicare and regulations. After Medicare identifies an overpayment, the overpayment amount becomes a debt you owe the Federal government. Federal law requires the Centers for Medicare and Medicaid Services (CMS) to try to recover all identified overpayments.

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Published in the April 17, 2017 OBS Newsletter

CMS Guidelines vs AMA CPT Definition of Co-Surgery (Two Surgeons) Modifier 62

For certain procedures, co-surgeons could be paid by submitting the required supportive documentation to establish the medical necessity of two surgeons for the procedure.
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Published in the April 2017 OBC Newsletter

Endoscopic Procedures: Be Aware of the Summary of “Family Codes”

Special rules for multiple endoscopic procedures apply if a procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure).
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Published in the January 2017 OBC Newsletter

Abdominal Aortic Aneurysm Screening CPT Code Update

A new CPT code (76706) was established to bill abdominal aortic aneurysm (AAA) screening.
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Published in the April 2017 OBC Newsletter

G Codes For Mammography

CMS has introduced new codes for mammography procedures, both diagnostic and screening.
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Published in the April 2017 OBC Newsletter

Fraud, Waste and Abuse UHealth Compliance 2016

Thank you for being an integral part of the UHEALTH compliance effort! As with all strong programs, it starts with communication and training. All University of Miami UHealth/Miller School of Medicine faculty and employees are required to complete the mandatory UHealth Fraud, Waste and Abuse 2016 (FWA) Training. Read More


Published in the January 2017 OBC Newsletter

Medicare Finalizes New Physician Payment System

The Centers for Medicare & Medicaid Services (CMS) released a final rule implementing a new Medicare physician payment system. Beginning in 2017, physician practices can choose between two payment options…
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Published in the January 2017 OBC Newsletter

Observation Services

Outpatient observation services are not to be used as a substitute for medically necessary inpatient admissions. Additionally, there must be medical necessity for observation beyond the usual recovery period (4 to 6 hours).
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Published in the January 2017 OBC Newsletter

New Physician Specialty Code for Hospitalist

Effective April 1, 2017, a new physician specialty code for hospitalist will be implemented.
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Published in the January 2017 OBC Newsletter

2017 Hospital Outpatient and ASC Prospective Payment System Highlights

On November 1, 2016, CMS released its final 2017 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule.
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Published in the January 2017 OBC Newsletter

Moderate Sedation and Endoscopic Services

For CY 2017, CMS unbundled moderate sedation for some endoscopic services and will require sedation to be separately billed using designated CPT code(s), when provided.
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Published in the January 2017 OBC Newsletter

2017 Office of Inspector General Work Plan Hospital Initiatives

The Department of Health and Human Services Office of Inspector General publishes its Work Plan for the upcoming fiscal year.
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Published in the January 2017 OBC Newsletter

2017 ICD-10 Changes

The 2017 update to the ICD-10-CM diagnosis coding structure is effective for services rendered on or after October 1, 2016.
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Published in the January 2017 OBC Newsletter

2017 Medicare Physician Fee Schedule (MPFS)

Select from the links below to view the disclosure report for your locality
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Published in the January 2017 OBC Newsletter

The Importance of the Medicare Coverage Analysis in Clinical Trials

To ensure appropriate reimbursement for the services provided to a patient in a clinical trial, research sites must develop a budget for each trial.
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Published in the January 2017 OBC Newsletter

False Claims Act Settlement

South Miami Hospital, has agreed to pay the United States approximately $12 million to settle False Claims Act allegations .
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Published in the January 2017 OBC Newsletter

What Is The Minimum Required Documentation When Billing For A Split/Shared Visit?

The physician provides a medically necessary face-to-face portion of the E/M encounter …
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Published in the January 2017 OBC Newsletter

Patient Admission Orders

An inpatient admission is appropriate for payment under Medicare Part A when the admitting physician expects the patient to require hospital care that crosses two midnights.

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Published in the April 2017 OBC Newsletter

2017 Physical Therapy Payment Caps

Starting on January 1, 2017 the limit on incurred expenses for physical therapy will be $1,980 for physical therapy and speech-language pathology services combined.

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Published in the April 2017 OBC Newsletter

Myocardial Perfusion Imaging

When a Myocardial Perfusion Imaging (MPI) is performed, the current procedural terminology (CPT) code that should be used is 78452.
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Published in the April 2017 OBC Newsletter

Authenticating Orders

A hospital must make sure that all orders, including verbal orders, are dated, timed and authenticated promptly.

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Published in the April 2017 OBC Newsletter

Clinical Research Participant Enrollment and Tracking In Velos

All participants enrolled in clinical research protocols must be registered in the Velos clinical trial management system within 48 hours of obtaining informed consent.
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