On April 14, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed the Senate by an overwhelming vote of 92-8. Although President Obama has not officially signed the bill into law, weeks ago he indicated his full support when H.R. 2 passed the House of Representatives.

Mac Jurisdictions Resources (Resource 396)

The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called

Medicare Improper Payment Report for Behavioral Health Services

The following information is from the 2014 Medicare Improper Payments Report by the Department of Health and Human Services.

This table shows the Improper Payment Rates by Provider Type and Type of Error for Medicare Part B claims:

    Provider Type

    Improper Payment Rate

It appears that the repeal of the Sustainable Growth Rate formula (SGR) could finally be a real possibility. On Thursday, March 26, The U.S. House of Representatives overwhelmingly passed H.R 2, The Medicare Access and CHIP Reauthorization Act which includes both repeal and replace the flawed SGR formula that has caused a great deal of disruption to the Medicare payment system over the last several years. H.R.

Sustainable Growth Rate (Resource 230)

What is the Sustainable

Modifier Resources (Resource 343)

Modifiers proved a way for the practitioner to report or indicate that a procedure or service has been performed but has been altered by some specific circumstance. Modifiers are essential tools in the coding process. They are used to enhance a code narrative to describe the circumstances of each procedure or service and how it individually applies to the patient. The appropriate use of modifiers enable practitioners to effectively respond to payment policy requirements to payer policies.

Instructions for: Medicare Redetermination Request (Resource 241)

The Medicare Redetermination Request is the first step in the Medicare Appeals process.

After the initial determination and denial, the Redetermination review process is performed by your contractor. Your request must be submitted in written form. Your contractor generally makes a decision within 60 days from the timethey receive your request. This decision will be in the form of a letter, Medicare Summary Notice (MSN), or Remittance Advice (RA).

Of nearly 15,000 test claims received by the Centers for Medicare & Medicaid for the first round of end-to-end ICD-10 testing, 81 percent were accepted, according to statistics revealed by the agency Wednesday.

Medicare Resources (Resource 210)

For detailed information on this government program, as it relates to Behavioral Health services, see Section C-Medicare in the Behavioral Health DeskBook.

You need to understand the following concepts:

Government Healthcare Programs (Resource 162)

The Department of Health and Human Services (HHS) oversees all government health care programs. They are administered by various agencies such as the Centers for Medicare & Medicaid Services (CMS), the Veterans Administration (VA) and even at the state level. Here are the basic government programs:


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