decisionhealth Newsletters, Part B News - 2008 Issue 3 (March)
PPAC: Go back to legacy numbers if NPI-only rejections jump
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Article Overview
This article reports on a March PPAC meeting focused on Medicare claims processing and audit policy. It discusses CMS and council-member recommendations about monitoring claim rejection rates after the NPI-only deadline, along with broader concerns about RAC demonstration results, audit selection factors, appeals, and reporting transparency. The piece is relevant to physicians, billing and compliance staff, and anyone tracking Medicare administrative changes.
Why This Topic Matters
It highlights operational issues that can affect claim acceptance, audit exposure, and the amount of information available to providers about CMS program performance.
Article Sections
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NPI-only claims processing concerns
Discussion of CMS implementation status, PPAC recommendations, and monitoring of Medicare claim rejection trends after the NPI-only transition.
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RACs lead to lively debate
Summary of PPAC discussion about Recovery Audit Contractors, including audit selection, reporting, appeals, and the status of the RAC demonstration program.
What You Will Learn
- What policy concerns were raised about the transition to NPI-only claims processing
- What kinds of monitoring and reporting PPAC urged CMS to provide
- What issues were discussed regarding Recovery Audit Contractors and Medicare audits
- What aspects of RAC performance and appeals transparency were emphasized during the meeting
Who Should Read This
- Physicians
- Medical billing staff
- Coding professionals
- Practice managers
- Compliance officers
- Health policy analysts
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