Cms oig

BACKGROUND: During the past decade, a variety of federal regulations have had a significant impact on the way allergen immunotherapy is reimbursed and how Current Procedural Terminology (CPT) codes are used for this purpose. As mandated by the US Congress, the Centers for Medicare and Medicaid Services (CMS) through the Office of the Inspector General (OIG) targeted immunotherapy codes for scrutiny, because they are some of the most frequently used codes. OBJECTIVE: To examine how federal regulations have affected reimbursement for allergy immunotherapy and other allergy services...

Accurate coding of medical services is a constant challenge for physicians and could jeopardize a practice if not taken seriously. Insurance carriers use sophisticated claims-processing software that easily identifies coding trends by physicians and flags outliers within specialties. The Office of Inspector General (OIG) and the Center for Medicare and Medicaid Services (CMS) hire auditors to identify areas for review which are commonly miscoded. One area that has been flagged for review is billing with modifier -59 because misuse of this modifier has increased inappropriate reimbursement...

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CMS and the OIG are examining payment for residents' training in nonhospital settings. Over the next year, as the current moratorium on Medicare disallowances of GME and IME payments for these residents comes to a close, providers should stay up to date on the latest developments and anticipate changes that are likely to follow.

No abstract text is available yet for this article.