December 22, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein On September 30, 2023, the U.S. Department of Justice announced a $172 million False Claims Act (FCA) settlement with Cigna relating to the submission of invalid HCC diagnosis codes to CMS in order to increase Medicare Advantage member risk scores, and therefore,…
Amy C. Pritchett, CCS, CRC, CPA-RA, CPC, CPMA, CPCO, CDEI, CDEO, CDEC, CANPC, CASCC, CMPM Manager, HCC Coding/Audit & Education Services, Pinnacle Enterprise Risk Consulting Services AAPC Fellow |Approved Instructor |ICD-10-CM/PCS Trainer On March 31, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Advantage (MA) Capitation Rates along…
October 3, 2023 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Have you seen the new AMA Smart Brief on Modifier 25 that was released on August 17th? That’s what I want to talk to you about today. I want to break down the information because I specifically noticed there is a stark…
Let’s have a conversation about the data column on MDM. Specifically, what I’d like to address is imaging services. When a provider performs an x-ray while seeing a patient, and they are not going to bill a professional component of that test, how do we count that service? Is that service something we can count?…
September 29, 2023 | By Grant Huang, CPMA, CPC If you’ve never heard of principal care management (PCM) or chronic care management (CCM) services before, you’re not alone. Medicare introduced these new benefits for Part B beneficiaries in 2021 and 2022, respectively, but the agency’s own utilization data shows that adoption has been fairly…