Becker's Healthcare September 26, 2024
On Sept. 24, CMS issued a final ruling to address “significant, anomalous and highly suspect” billing activity on the Medicare Shared Savings program to mitigate financial impacts for Accountable Care Organizations.
Here are six things to know:
1. The 2025 Physician Fee Schedule includes a methodology to address suspicious billing activity from 2024 onward.
2. The bill addressed two CPT codes identified as suspect:
- A4352, intermittent urinary catheter; Coude (curved) tip, with or without coding
- A4353, intermittent urinary catheter, with insertion supplies
3. Payments for these codes are excluded. Codes are considered suspect when there is an unexplained spike in claims either in volume or dollar amounts, at the regional or national level.
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Topics: ACO (Accountable Care), CMS, Govt Agencies, Insurance, Medicare, Payment Models, Provider, Value Based