tci Medicare Compliance & Reimbursement - 2014 Issue 4
Industry Notes:
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Article Overview
This article is a roundup of Medicare and health care compliance news for providers, billing staff, and coding professionals. It summarizes MAC testing logistics for ICD-10, CMS guidance related to psychiatry and psychotherapy billing documentation, a Department of Justice update on Medicare fraud enforcement, an OIG advisory opinion affecting referral arrangements, and a home health MAC reminder about common denial issues tied to face-to-face encounter documentation. The piece is useful for readers who track payer operations, documentation requirements, and federal compliance developments.
Why This Topic Matters
The article brings together several practical Medicare-related updates that can affect claim preparation, documentation practices, compliance risk, and denial management. It helps providers and revenue cycle teams identify which operational changes and policy reminders may be relevant to their workflows.
Article Sections
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Several MACs Open Up ICD-10 Testing Registrations
Overview of Medicare Administrative Contractor testing activity, registration timing, and claim submission preparation related to the ICD-10 transition. The section focuses on general testing logistics and payer coordination.
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CMS: Time Is On Your Side For Psych Billing
Discussion of CMS guidance addressing documentation and billing issues associated with psychiatry and psychotherapy services. The section summarizes the general compliance concerns raised by revised coding guidance.
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Medicare Strike Force Prosecutes Record Number Of Healthcare Fraudsters
Summary of Department of Justice reporting on Medicare fraud enforcement activity and strike force operations. The section covers broad enforcement trends and geographic focus areas.
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OIG Tells Provider It’s OK To Pay For Referrals
Coverage of an HHS Office of Inspector General advisory opinion involving referral arrangements for a provider with multiple service lines. The section describes the general structure of the arrangement and the agency’s advisory review.
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Face-To-Face Rises To Top Of HHA Claims Denial List
Reminder from a home health Medicare Administrative Contractor about denial trends and documentation issues. The section focuses on the broader topic of claim denials tied to face-to-face encounter requirements.
What You Will Learn
- How MACs are organizing ICD-10 testing opportunities and what general preparation issues are highlighted
- What CMS is emphasizing about documentation concerns in psychiatry and psychotherapy billing
- What the DOJ reported about Medicare fraud enforcement activity and strike force operations
- What type of provider referral arrangement was addressed in an OIG advisory opinion
- Why face-to-face documentation is a major source of home health claim denials
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle managers
- Compliance officers
- Home health agencies
- Physician practices
- Health care administrators
Codes Discussed
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