E/M Coding Alert - 2019 Issue 19
Industry Notes: CMS Updates Dual Eligible Guidance On ABNs
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Article Overview
This article summarizes a CMS paperwork and instruction update related to Advance Beneficiary Notices for dual eligible beneficiaries and explains why the change matters for providers handling Medicare and Medicaid coverage coordination. It also reports on a Department of Justice enforcement action tied to alleged genetic testing fraud involving telemedicine and laboratory billing. The piece is relevant to billing, compliance, and healthcare fraud-and-abuse audiences following Medicare policy updates and federal enforcement activity.
Why This Topic Matters
Providers, compliance teams, and revenue cycle staff need to track CMS instruction changes that affect beneficiary notices and claim handling for dual eligible patients. The article also highlights a major fraud enforcement action that underscores current federal scrutiny of telemedicine-driven testing schemes and improper Medicare billing.
What You Will Learn
- What CMS is updating in its Advance Beneficiary Notice instructions for dual eligible beneficiaries
- How the article frames Medicare and Medicaid coordination issues at a high level
- What federal enforcement activity is being reported alongside the CMS update
- Why the article is relevant to compliance and billing stakeholders
Who Should Read This
- Medical coders
- Billing and claims staff
- Compliance officers
- Revenue cycle professionals
- Healthcare administrators
- Hospice and home care organizations
- Fraud and abuse investigators
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