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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.

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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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Billing Guidelines for Medicare Home Infusion Therapy (HIT)

Medisys Compliance

Under Fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. Likewise, nursing services are necessary to train and educate the patient and caregivers on the safe administration of infusion drugs in the home.

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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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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. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules.

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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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Medicare Coverage for Chiropractic Manipulative Treatment (CMT)

Medisys Compliance

Medicare covers limited chiropractic services when performed by a chiropractor who is licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. Medicare Coverage. American Medical Association. All Rights Reserved. Reference: [link].