CMS New Claims Approach For Physicians

It looks like the government is moving forward with reducing the regulatory burden that’s on physicians. Now, it looks like they are doing fewer audits but more targeted Medicare audits. Under a new Medicare claims review process, fewer physicians will undergo audits. This was recently announced by Centers for Medicare & Medicaid Services (CMS).

CMS New Claims Approach

CMS is coming out with a new claims approach review that will be nationwide. The review targets fewer providers while also requiring the review of fewer claims. Issued to go into effect later this year, the claims approach makes doctors who have good moral billing practices less likely to face a Medicare audit. Health and Human Services Secretary, Tom Price, as well as CMS’ head, Seema Verma, have said these actions are being used to reduce the regulatory burden put on doctors. It seems that this is a priority for the Trump administration.

CMS New Proposed Rules Under MACRA

In June, CMS issued a proposed rule that updates the Medicare physician payment system under the Medicare Access and CHIP Reauthorization Act (MACRA). The changes would make it easier for small independent practices to participate. On 8/21/17 CMS updated their website, stating they would be revising its medical review process. The revision would target only specific providers/suppliers who have billed Medicare for specific services, rather than all of them. Under the program called “Targeted Probe and Educate Program,” Medicare admin contractors will focus only on the highest claim error rates or billing practices. This will enact only on providers/suppliers that vary significantly from their peers. This was part of the Trump administration’s commitment to reduce government regulations.

Certification for Plan Year 2018

For the plan year 2018, the CMS is offering training for the Marketplace Learning Management System (MLMS). Training can also be done through three CMS-approved vendors: America’s Health Insurance Plans, Inc. (AHIP), the National Association of Health Underwriters (NAHU), and Litmos by CallidusCloud. Log in to the Centers for Medicare & Medicaid Services secure portal to get started now!

If you have any questions, please call us toll-free (888) 539-1633.

Don’t Forget to Follow Us on Social Media