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Understanding Basics of Medicare Overpayment

Medisys Compliance

What is Medicare Overpayment? Identified overpayments are debts owed to the federal government. A Medicare overpayment exceeds regulation and statute properly payable amounts. When Medicare identifies an overpayment, the amount becomes a debt a healthcare provider owes the federal government.

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Wrongly Denied Claims by Private Medicare Plans

Medisys Compliance

Recently published watchdog report found that private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. For detailed understanding we shared observations of OIG where they found that some of the claims were wrongly denied by private Medicare plans.

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Basics of Medicare Administrative Contractor (MAC)

Medisys Compliance

What’s a Medicare Administrative Contractor (MAC)? Its quite common for any provider to get confused while billing to Medicare for healthcare services, as they not billing to Medicare but to a MAC. million health care providers who are enrolled in the Medicare FFS program. Activities done by MACs.

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Billing Medicare Telehealth during COVID-19 PHE

Medisys Compliance

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located.

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Diabetes Education Billing Guidelines for Medicare

Medisys Compliance

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

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Proposed Rule on Medicare Special Enrollment Periods (SEPs)

Medisys Compliance

On 22 nd April 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules.

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Navigating Payer Audits and Reimbursement Challenges in Cardiology Billing

Medisys Compliance

Understanding the Landscape of Cardiology Billing Cardiology billing encompasses a wide range of services, including diagnostic testing, interventional procedures, and ongoing patient care. These audits can be time-consuming and resource-intensive if not managed effectively.