Last week, CMS issued guidance for providers pursuant to the announcement on February 9th that the Public Health Emergency (PHE) for COVID-19 will end on May 11, 2023. They have provided several fact sheets that contain guidance for providers in anticipation of the end of the PHE. While many of
Last week CMS issued Transmittal 11842. The Transmittal outlines changes to the instructions for Evaluation and Management (E/M) services within the Medicare Claims Processing Manual. These changes are consistent with those outlined within the Medicare Physician Fee Schedule Final Rule. However, there is an alarming instruction with respect to contractors
Yesterday, CMS released the Medicare Advantage (MA) Risk Adjustment Data Validation Final Rule. The Final Rule is intended to strengthen the accuracy of risk adjustment payments made by CMS to MA plans and reduce the amount of overpayments related to improperly reported diagnoses. CMS makes payments to MA plans based,
Happy New Year from the HBE Advisors team! As we begin 2023, it is a great time to validate your coding and compliance programs are up to date with the latest CPT, ICD-10 and HCPCS releases and that your auditing and monitoring program includes the latest risk areas. January 1,
2022 Medicare Fee-For-Service Improper Payments Report was just released. The report identified an estimated $31.46 billion in improper payments with a payment error rate of 7.46%. The report outlines findings related to services most frequently billed and paid in error along reasons for the errors, such as medical necessity, incorrect
The OIG has issued their Semiannual Report to Congress for the period April 1, 2022 through September 30, 2022. The report highlights over $4 billion in expected investigative and audit recoveries identified during the entirety of FY 2022. The report details the OIG’s ongoing work through investigations and enforcement actions during this
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