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CMS To Expand Targeted Probe and Education Program

Citing a decrease in appealed claim decisions and an increase in the acceptance of provider education under the pilot program, CMS has announced that they have decided to expand the Targeted Probe and Educate (TPE) program to all MAC jurisdictions in latter part of 2017. The TPE program grew out of the broad Probe and Educate program initiated by CMS in 2014. The TPE program began as a pilot in one MAC jurisdiction in June 2016 and was expanded to three additional MAC jurisdictions in July 2017. Continue reading

Appeals Court Overturns Ruling Requiring HHS to Clear Medicare Appeals Backlog By 2021

On Friday, the U.S. Appeals Court for the District of Columbia overturned an order requiring Department of Health and Human Services (HHS) to clear its backlog of Medicare reimbursement appeals by the end of 2020. Indicating that the district court “declined to seriously grapple with the Secretary’s assertion that lawful compliance with such a mandamus order would be impossible,” the appellate court ruled that it was an “error or law” and an “abuse of discretion” for the district court to order the Secretary to perform an act – clear the backlog by certain deadlines – without evaluating whether performance was possible. Continue reading

CMS proposes removing total knee replacements from inpatient-only list

In the 2018 OPPS proposed rule, CMS is moving ahead with a proposal to remove total knee replacements under CPT code 27477 (arthroplasty, knee, condyle and plateau; medial and lateral components with or without patella resurfacing (total knee arthroplasty)) from the inpatient-only list. If finalized, the procedure would be added to comprehensive APC (C-APC) 5115 (Level 5 Musculoskeletal Procedures) and assigned status indicator J1 (hospital Part B services paid through a C-APC).

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Join Us for a Live Webinar, “Medical Necessity Documentation, Challenges and Defense”

We are pleased to announce that Fotheringill & Wade founder and principal, Linda Fotheringill, and Senior Attorney Sarah Mendiola will be speaking in an upcoming Strafford live webinar, “Medical Necessity Documentation, Challenges and Defense” scheduled for Wednesday, March 22, 1:00pm-2:30pm EDT. Because of your affiliation with F&W, you are eligible to attend this program at half off. As long as you use the links in this post, the offer will be reflected automatically in your cart. Continue reading