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Testing for compliance with the CMS-13 list of diagnostic categories can be down through presumptive methodology or medical review.
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In the 1934 movie “Death Takes a Holiday,” Death, played by the venerable Fredric March, takes a three-day holiday to find out why everyone fears him. During his respite, no one dies from disease or accidents. Unlike in the movie, in real life Death doesn’t go on vacation but works…
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In another example of Medicare Administrative Contractors (MACs) contradicting the Centers for Medicare & Medicaid Services (CMS), National Government Services (NGS) on Friday issued a news and alert bulletin that was both controversial and confusing. In the alert, NGS stated that outpatient therapeutic pheresis procedures “must be performed by physicians…
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The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently conducted an audit of Mount Sinai Hospital in New York City. After looking at a sample, the OIG found fault with about $1.4 million in claims, and projected that to an overpayment of just under $42…