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Is your facility ready to reopen its doors to the general public? Phase 1 guidance, released last week by the Centers for Medicare & Medicaid Services (CMS), provides recommendations for reopening facilities providing non-emergent, non-COVID-19 healthcare. At this time, many parts of the country have a low or relatively low and stable incidence of COVID-19 […]
The post Facilities Receive Guidelines for Non-COVID-19 Healthcare appeared first on AAPC Knowledge Center.
Reimbursements for sponsoring meetings and hosting exams are paid quarterly from AAPC into the chapter checking accounts according to the following schedule: Months in the quarters: Mark attendance by: Payments will appear in accounts: 1st Q – Jan, Feb, Mar 30 days after each meeting […]
The post Prepare Now to Receive the 1st Q Reimbursement in May appeared first on AAPC Knowledge Center.
Review emergency preparedness policies with your visiting staff. The Centers for Medicare & Medicaid Services (CMS) has stepped in with provider-specific guidance to help home health and hospice agencies prepare and operate in the face of the COVID-19 pandemic. Monitor for Signs and Symptoms HHAs should be monitoring the health status of everyone (patients/residents/visitors/staff/etc.) in […]
The post HHAs, Hospices Receive COVID-19 Guidance appeared first on AAPC Knowledge Center.
The provider will then submit a dispute with altered, not amended documentation, not corrected, completely altered, and request payment for the Prolonged Service.
We are working towards education of the provider in the hopes that they are unaware that this is illegal but we need to provide them with all of the proper documentation to support our determination that they cannot do this. We have the Medicare Guidelines on how the amendments, corrections, and addendums are supposed to be done, MLN Matters SE1237. What I’m looking for are specific guidelines or Medicare requirements stating that these cannot be added after a claim has been denied for level of service just be able to get paid for the level of service.
Can anyone help with this?
I’m trying to find documentation from CMS or the False Claims Act that specifically indicates that it is fraud or false reporting of claims to bill out a lower level code for reimbursement when the higher level code that actually occurred is not payable due to the fact that an authorization was not obtained. Since the lower level does not require an auth and auth wasn’t obtained for the actual level of care that was provided, I’m being asked to downcode to the level that does not require an auth. This is not just for one claim here or there, this is between 50-80% of the services provided where auths weren’t obtained for the correct level of care so the provider wants them downcoded to the level that doesn’t require an auth.
Does anyone have documentation that they could send me from CMS or from the False Claims Act that specifically mentions downcoding abuse.
Thank you for your help!