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CMS’ newest program aims to facilitate value-based payment participation. The Centers for Medicare & Medicaid Services (CMS) has a new goal: Get 100 percent of traditional Medicare beneficiaries and most Medicaid beneficiaries into accountable care relationships by 2030. Strengthening the U.S. primary care infrastructure has been an ongoing project for CMS, and they aim to […]
The post Making Care Primary: Strategic Support for Accountable Care appeared first on AAPC Knowledge Center.
Learn how pharmacist patient care is evolving. If you’re not sure what pharmacists do in clinical practice or how to report the services they provide, you are not alone. Although pharmacists have provided information in conjunction with the dispensing of prescriptions for decades, providing services separate and distinct from dispensing medications is a much newer […]
The post Applying RVUs to Pharmacists’ Patient Care Services appeared first on AAPC Knowledge Center.
Medicare updates its policy for these services to align with CPT®. The Centers for Medicare & Medicaid Services (CMS) revised its Part B benefit policy for critical care services, effective Jan. 1, 2022. Policy changes finalized in the 2022 Medicare Physician Fee Schedule (MPFS) final rule include a new definition of critical care services, who […]
The post Coding Critical Care in 2022 appeared first on AAPC Knowledge Center.
Medicare Advantage Organization denials raise concerns that private insurers are maximizing profits at the expense of patients. Every year, tens of thousands of people enrolled in private Medicare Advantage (MA) plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on April 27. The Department of […]
The post MA Plans Wrongly Deny Needed Care, Physician Payments appeared first on AAPC Knowledge Center.
American Rescue Plan offers new option for states to extend Medicaid and CHIP coverage to 12 months after pregnancy. Pregnant and postpartum people may now be guaranteed Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months after pregnancy instead of the current two months of coverage. Beginning April 1, 2022, the American Rescue […]
The post Postpartum Care Expanded appeared first on AAPC Knowledge Center.
On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or […]
The post Append Modifier FT for Unrelated Critical Care Services appeared first on AAPC Knowledge Center.
Mobile crisis intervention services deliver fast, appropriate care to individuals in crisis and help to avoid unnecessary, costly ER visits and hospitalizations. In an effort to expand behavioral health support in communities, the U.S. Department of Health & Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced Dec. 28, 2021, that […]
The post New Medicaid Option Promotes Mobile Crisis Intervention Care appeared first on AAPC Knowledge Center.
Tallahassee Health Care Provider Arrested for Medicaid Fraud
A Tallahassee health care provider has been arrested for billing the Florida Medicaid Program around $ 50,000 for fraudulent medical services, according to Florida Attorney General Ashley Moody.
Rodney Burt, 57, was arrested Friday on Medicaid fraud charges after he billed the state’s Medicaid program for phony services from May 2016 to November 2019, the press release said.
“That is why my Medicaid Fraud Control Unit attorneys and investigators aggressively chase down leads and uncover abuses in this taxpayer funded health care program to ensure those who would aim to rip off taxpayers are stopped and brought to justice.”
The investigation revealed he was assigning inaccurate billing codes to claims he submitted to the Florida Medicaid Program to increase reimbursements, which fraud investigators call “upcoding.” Burt’s charge of Medicaid provider fraud of $ 50,000 or more is a first-degree felony.
The post Tallahassee Health Care Provider Arrested for Medicaid Fraud appeared first on The Coding Network.
CMS selects primary care payment model participants
According to Becker’s Hospital Review, “CMS chose 916 primary care practices and 37 regional health plan partners as participants in its new payment model called Primary Care First.
PCF was designed to decrease the amount of avoidable hospital visits and total cost of care through performance-based adjustments. The practices CMS selected as participants generally include primary care clinicians who serve seriously ill populations in high need of care.
Participants will start using the alternative payment model Jan. 1, 2021, and CMS plans to test the model for five years.”
The post CMS Selects Primary Care Payment Model Participants appeared first on The Coding Network.
New website is tailored to mobile devices. COVID-19 may have delayed the revamp of Medicare’s Compare web tools, but it didn’t scuttle the effort altogether. The Medicare Care Compare website, which rolls up its eight separate Compare websites, including Home Health Compare and Hospice Compare, launched Sept. 3. The Centers for Medicare & Medicaid Services […]
The post Care Compare Goes Hi-Tech appeared first on AAPC Knowledge Center.