Beginning this month, Centers for Medicare and Medicaid Services (CMS) will conduct data validation and audits of a select number of Merit-based Incentive Payment System (MIPS) eligible clinicians for performance years 2017 and 2018. Practices targeted will receive a request for information from CMS' ... What do you need to know about MIPS audits?
The Merit-based Incentive Payment System (MIPS) is a program that evaluates and rewards participating providers based on data reported in four performance categories: Quality, Promoting Interoperability, Cost, and Improvement Activities. Starting in June 2019, Humana Medicare Advantage plans will use MIPS payment adjustment rates ... Learn about the Humana updates
The Michigan Department of Health and Human Services (MDHHS) Third Party Liability Division (TPL) partners with commercial health insurance companies to receive their coverage information. This information is directly verified with their official eligibility source. Each insurance company assures that policies in CHAMPS are ... Read about the TPL Commercial Coverage
Not Otherwise Classified (NOC) codes are used for services that do not have an existing CPT code that accurately identifies the service or procedure performed. Services billed under NOC codes will be denied as billing errors if codes describing the services are available. Wisconsin Physicians Service (WPS) ... View the examples
The Merit-based Incentive Payment System (MIPS) is a program through which participating providers are evaluated and rewarded for improvement based on their performance in four categories. Performance is measured through data reported in four areas: Quality - 45% Promoting Interoperability - 25% ... Read the resources
Collection problems are very serious to the financial health of your medical practice. You may find costs and overhead going up while cash flow goes down. To make matters worse, your office is probably spending more time than ever before contending with third party regulations and rejected ... Learn More
WPS Government Health Administrators (WPS GHA) is authorized by the Centers for Medicare and Medicaid Services (CMS) to conduct the Targeted Probe and Educate (TPE) review process. This process is required of the providers identified by Medical Review. The TPE review process involves three rounds of pre-and ... Learn More
Each month, the Office of Inspector General (OIG) publishes various Work Plans (topics) that target concerns raised by Congress, the Centers for Medicare and Medicaid Services (CMS) and other organizations, on which the OIG will focus for the current fiscal year or beyond. Following ... Learn More