General Surgery Coding Alert - 2011 Issue 10
Industry Notes
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Article Overview
This article reviews several Medicare payment and compliance updates of interest to hospice providers, physician practices, and coding/reimbursement staff. It discusses CMS comments about documenting hospice services that may be considered unrelated to a terminal diagnosis, summarizes recent recovery audit contractor activity, and reports on payment totals from physician quality and e-prescribing incentive programs.
Why This Topic Matters
It helps readers gauge current Medicare audit focus areas and understand broader CMS payment trends that may affect documentation, claims review, and incentive participation.
Article Sections
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Hospice documentation and terminal diagnosis guidance
Discusses CMS commentary on documentation and coverage concerns for hospice services billed in relation to terminal conditions. The section focuses on how regional offices are reviewing hospice-related payment issues.
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RAC overpayment and underpayment activity
Summarizes national recovery audit contractor results for a recent reporting period. It covers the overall volume of incorrect Medicare payments identified and the return of funds to providers.
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Example of a RAC finding
Provides a brief illustration of one type of billing error identified in the audit report. The example is used to show the kind of payment issue reviewed by auditors.
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PQRS and ePrescribing incentive payments
Reviews CMS reporting on incentive program payments made to physicians and other eligible professionals. The section highlights the programs’ broader purpose and the settings where most payments were made.
What You Will Learn
- How CMS is framing hospice documentation concerns related to terminal diagnoses
- What the recent RAC payment summary showed about incorrect Medicare payments
- What types of billing issues appeared in the CMS audit report examples
- How PQRS and ePrescribing incentive payments were distributed in the reported year
Who Should Read This
- Hospice providers
- Physician practices
- Medical coders
- Billing staff
- Compliance teams
- Revenue cycle professionals
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