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Fraud, Waste & Abuse
CMS Announces New Measures to Strengthen Medicare and Medicaid Fraud Prevention
CMS has announced new actions aimed at strengthening fraud prevention within Medicare and Medicaid programs. The initiative focuses on improving oversight, protecting patients and taxpayers, and preventing improper payments before they occur.
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FDA Recalls
MIPS
Final MIPS Countdown
Final Countdown: The 2025 MIPS Submission Window Closes March 15
The clock is officially ticking for healthcare providers participating in the Merit-based Incentive Payment System (MIPS). If you haven't finalized your data for the 2025 performance year, it’s time to shift into high gear. The deadline to submit your data to the Registry Clearinghouse Basic clients has passed and the deadline for those with the premium plan has been extended to March 15, 2026.
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Coding
Orthotic Billing for an E/M Service on the Same Date of Service
A claim for orthotics, L3000 right and L3000 left is being sent to Care-First Blue Cross Blue Shield Washington DC. Question: is Place of Service still #12 (Home)?
I ask because a claim was recently denied for POS 12 for orthotics (too early to know if changing it to Place of Service 11 for Office was successful.
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FDA Recalls
Coding
Wound Care Billing Debridement Codes
“I do some part time work in a wound care center. I frequently use CPT 97597 for coding. My biller is telling me not to bill CPT 97597 because it reimburses around $25 or less in a wound care center. However, the facility likes and even encourages me to use CPT 97597. If I do a selective debridement, can I bill CPT 99213 or CPT 99212 instead of CPT 97597? I know that I should not bill CPT 99213-Modifier 25 if there isn’t a separate complaint. Am I required to bill 97597? Is this a scenario that I should be considering CPT 11042?”
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