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CMS Kicks Off Second Year of Medicare Compliance Newsletters

James Carroll for HealthLeaders Media, November 15, 2011

It's clear that providers must be more cognizant of the rules as they relate to different services provided within the hospital, according to Elizabeth Lamkin, MHA, partner,PACE Healthcare Consulting, LLC.

"For instance," she continued, " if a physician performs a procedure in the hospital setting, the Part B physician will be reimbursed at a lower rate because the physician is using hospital resources, and typically the hospital (Part A) will charge a facility fee."

In addition, Lamkin suggests that billing errors such as the highlighted issues above will now be easier to notice, which will help to recognize further problematic billing errors for providers.

"These billing errors are going to be much easier to identify with all providers under MAC regions because the MACs can view an episode of care across Medicare parts A, B, C, and D," she says. "The dates and services provided must match the rules, and providers should be collaborating to be compliant with all billing procedures or face being vulnerable to a RA (recovery auditor) takeback or denial."

When challenging billing issues such as these are identified for providers, it serves as a valuable source of information, says Donna Wilson RHIA, CCS, CCDS, senior director at Compliance Concepts, Inc., in Wexford, PA.

"What a great resource for providers regarding the major findings of RAC auditors throughout the nation," she says. "Oftentimes, CMS guidance can be confusing to providers, but having these simple patient examples will hopefully assist providers in some unanswered questions."

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