Reimbursement: Expect to Recoup Money You Lost to Two Troublesome Edits

Why This Topic Matters

These CMS revisions may affect whether certain previously denied claims can be resubmitted or adjusted, making the update important for reimbursement recovery and claims follow-up.

Article Sections

1. CMS edit reversal for ophthalmology evaluation services

   Summarizes CMS’s announced change to edits involving ophthalmology evaluation and management services and discusses the related claim-processing timing. The section also references CMS communications and resubmission-related guidance.

2. Transitional care management answers elucidated

   Covers CMS guidance on transitional care management billing and the availability of a CMS FAQ. It addresses the broader processing issues and the time frame discussed by CMS.

3. CMS attempting to rectify incarcerated patient denials

   Describes CMS efforts to correct claims that were misidentified as involving incarcerated beneficiaries. The section explains the agency’s plan for later claim adjustments and the status of appeals or demand letters.