Medicare Compliance & Reimbursement - 2013 Issue 30
Part B Payment: 2 Historically Bad CCI Edits Will Soon Be History, CMS Says
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Article Overview
This article summarizes Medicare Part B payment updates discussed by CMS, with a focus on edit changes affecting ophthalmology claims, transitional care management claim processing, and CMS corrections for claims misidentified as involving incarcerated beneficiaries. It is relevant to coders, billing staff, compliance teams, and practices that need to understand what CMS said about resubmission, appeals, and upcoming claims adjustments. The discussion centers on operational guidance, timing, and the categories of claims affected.
Why This Topic Matters
These CMS updates affect claim denial patterns, resubmission workflows, and when certain denied claims may be corrected or reconsidered. Practices that bill ophthalmology, transitional care management, or services affected by incarcerated-patient edits may need to adjust their follow-up processes and payment monitoring.
Article Sections
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CCI edit reversal for ophthalmology evaluation and management services
Discusses CMS remarks about upcoming changes to a pair of ophthalmology evaluation and management edits and the related claim-processing impact.
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Transitional care management billing guidance
Covers CMS comments on transitional care management claim processing, including timing and billing-related materials referenced during the forum.
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CMS corrections for incarcerated-patient denials
Explains CMS efforts to correct claims that were associated with incarcerated beneficiaries in error and the related adjustment timing.
What You Will Learn
- How CMS is revising certain Medicare claim edits affecting ophthalmology services
- What CMS highlighted about transitional care management claim processing
- How CMS is handling claims misidentified as involving incarcerated beneficiaries
- What types of follow-up actions practices may need to consider for denied claims
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Ophthalmology practices
- Primary care and specialty practices submitting Medicare claims
Codes Discussed
Modifiers Discussed
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