Outpatient Facility Coding Alert - 2013 Issue 21
Industry Note
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Article Overview
This brief industry note summarizes three separate Medicare and compliance updates. It explains a CMS improvement to the PECOS enrollment system, a Medicare contractor reminder involving emergency department diagnostic service billing, and a state fraud case involving allegations of false billing to Medicare and Medicaid. The article is aimed at providers, billing professionals, and compliance staff who need to stay current on enrollment and claims administration developments.
Why This Topic Matters
The note highlights operational changes and compliance reminders that can affect enrollment access, claim processing, and fraud-risk awareness for healthcare organizations and billing teams.
Article Sections
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CMS Improves Upon PECOS Enrollment System
Summarizes a CMS update to the PECOS enrollment platform and the related user-access improvements for providers and authorized personnel. It also notes an upcoming informational conference call.
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Modifier 77 Is Your Friend For Diagnostic ER Services
Covers a Medicare contractor reminder about emergency department diagnostic billing when services occur on the same date as another provider’s service. The section points readers to a CMS manual reference for additional guidance.
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Texas Physician Indicted In $1.4 Million Fraud Scheme
Describes a fraud indictment involving alleged false billing to Medicare and Medicaid and the resulting legal allegations. It also mentions the reported scale of the case and potential criminal penalties.
What You Will Learn
- What recent changes CMS made to the PECOS enrollment system
- What type of Medicare reminder was issued for diagnostic emergency room services
- What broad allegations were included in the Texas health care fraud case
- Which organizations and resources are referenced for additional information
Who Should Read This
- Healthcare providers
- Medical billing and coding professionals
- Practice administrators
- Compliance officers
- Revenue cycle staff
Modifiers Discussed
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