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CMS Date of Service Educational Materials/CMS Targeted Probe and Educate Initiative/Chiropractor and Physician Jointly Owned Entities

 

A few items of interest:

  1. CMS Education On Date of Services for Professional Claims. CMS has issued a new MLN Matters Article focusing on CMS policy for billing Part B professional services as related to the correct date of services to use. The article covers several specific services, such as radiology, clinical laboratory tests, home health certifications, diagnostic psychological tests, etc. Providers are encouraged to review the article for a refresher on which date of service to use when billing for services. To view the article, please go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17023.pdf.

  2. CMS Targeted Probe and Educate Initiative. CMS has announced that based on a successful pilot program, it will launch its Targeted Probe and Educate Medicare Review Strategy to all Medicare MACs. Medicare providers and suppliers will now be subject to Targeted Probe and Educate audits beginning this Fall. The audits will focus on limited audits of individual providers and provider education. According to CMS, the program will select claims for items/services that pose the greatest financial risk to Medicare and/or those that have a high national error rate. MACs will focus only on providers/suppliers who have the highest claim error rates or billing practices that vary significantly from similar providers/suppliers.

    The process includes a review of 20-40 claims followed by one-on-one, provider-specific, education to address any errors within the provider’s reviewed claims. Providers/suppliers with moderate and high error rates in the first round of reviews, will continue on to a second round of 20-40 reviews, followed by additional, provider specific, one-on-one education. Providers/suppliers with high error rates after round two will continue to a third and final round of reviews and education.

    It is important to be on the lookout for any communications related to this program that your entity may receive.

    For more information, please see: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Targeted-Probe-and-EducateTPE.html.

  3. Texas Eases Restrictions on Chiropractor Joint Practice with Others. This past session, SB 679 was passed by the Texas Legislature. It amends the Business Organizations Code to allow licensed chiropractors and doctors of medicine, osteopathy and podiatry to jointly own and operate corporations, partnerships, professional associations and professional limited liability companies. Each practitioner is limited to his or her scope of practice. For more information, please visit: Texas Legislature Online Website.


If you need help concerning any of this material, please contact Morey Glazer by phone at 972-385-0007 or by email at mglazer@glazerfinancial.com.

 

 

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