Medicare works to eliminate unbelievable claims
Rehab Regs, March 3, 2005
CMS is instructing contractors to screen unbelievable claims, according to PT Bulletin Online. Medicare advises contractors to screan claims for the same beneficiary, diagnosis code, date of service, and billing provider against criteria intended to identify excessive units of service. Transmittal 105 does not specify the codes and criteria Medicare carriers should enforce, but charges Correct Coding Initative (CCI) contractors to provide a list of "medically unbelieveable edits" to begin enforcing July 1. The new screens are aimed at reducing Medicare's paid claims error rate for fee-for-service billing. Visit http://www.cms.hhs.gov/manuals/pm_trans/R105PI.pdf to read the transmittal.
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