Part B News briefs

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes several Medicare Part B operational updates affecting billing and compliance. It covers remittance and denial code updates tied to PQRS reporting, common NPI-related denial issues for ordering and referring providers, and CMS audit guidance related to health professional shortage area bonus payments. The piece is relevant to billing staff, compliance teams, and practices that submit Medicare claims or manage provider enrollment and reporting workflows.

Why This Topic Matters

It highlights Medicare claim-processing and audit developments that can affect denial management, reporting workflows, and compliance oversight for Part B practices.

Article Sections

  1. Medicare remittance updates for PQRS reporting

    Overview of remittance and denial code changes connected to Medicare quality reporting for the 2014 reporting period. Also addresses related claim submission and billing workflow considerations.

  2. NPI-related claim denial issues

    Discussion of common provider identifier and name-entry problems that can lead to ordering and referring claim denials. Includes references to Medicare edits and enrollment verification resources.

  3. CMS disclosure of HPSA audit terms

    Summary of CMS audit activity involving health professional shortage area bonus payments. Describes the general audit focus and the provider groups and claim patterns under review.

What You Will Learn

  • How Medicare remittance updates relate to quality reporting claims
  • What types of provider identifier issues can lead to claim denials
  • What CMS disclosed about HPSA audit focus and review activity
  • Which operational areas billing and compliance teams should monitor in Part B workflows

Who Should Read This

  • Medical billers
  • Coding professionals
  • Compliance staff
  • Practice managers
  • Revenue cycle teams
  • Provider enrollment staff

Codes Discussed

Modifiers Discussed


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