CMS has noted that several high volume procedure codes are typically reported with a modifier that unbundles payment for visits from the procedure, even though the modifier should only be used for reporting services beyond those usually provided. Therefore, CMS believes the services may be misvalued. As a result, CMS is proposing to prioritize 83 services for review as potentially misvalued.
On Feb, 12, 2016, CMS issued its final rule implementing the Affordable Care Act (ACA) requirement that providers and suppliers report and repay overpayments from Medicare, known as the "60-Day Rule." The ACA requires a person who has received an overpayment to report and return the overpayment by the later of (a) 60 days after the date the overpayment was identified; or (b) the date any corresponding cost report is due, if applicable. Notably, the final rule imposes a look-back period of six years, a shorter time period than the ten year period set forth in a proposed version of the rulRead More
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