RT Welter & Associates Inc. is excited to share with you industry related news and medical updates. Thank you for joining. 
RT Welter & Associates

CMS Release: Medicare Reporting and Returning of Self-Identified Overpayments

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that requires Medicare Parts A and B health care providers and suppliers to report and return overpayments by the later of the date that is 60 days after the date an overpayment was identified, or the due date of any corresponding cost report, if applicable. A separate final rule was published in the May 23, 2014 Federal Register (79 FR 29844) that addresses Medicare Parts C and D overpayments.

The requirements in this rule are meant to support compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against improper payments, including fraudulent payment. This rule clarifies requirements for the reporting and returning of self identified overpayments. Health care providers and suppliers have been and will remain subject to the statutory requirements found in section 1128J(d) of the Social Security Act (the Act) and could face potential False Claims Act (FCA) liability, Civil Monetary Penalties Law (CMPL) liability, and exclusion from federal health care programs for failure to report and return an overpayment. Health care providers and suppliers will also continue to be required to comply with current CMS procedures when we, or our contractors, determine an overpayment exists and issue a demand letter.


Value Based Contracting

We have been saying it for years.
Value Based Contracting is coming
and in many markets it is here…
and it is here to stay! 

It is not a bad thing as long as it is transparent! Follow the money, if you cannot you should not sign the agreement! As in all economic transactions, both sides (all sides) need to be able to see and understand very clearly how it works. There are two messages here:  1) Value Based Contracting is a Market Solution – it is not and cannot be a ‘one-off’ solution where one practice or small group has a great idea and wants to keep it even semi-exclusive. Think BIG and solve BIG problems!  2) Physicians need to work together! That collaboration gene was beaten out of many docs through the battle to get into and out of medical school, getting the best residency and fellowship. We need it back! There is nothing more powerful and exciting than docs working together to solve the problems we have in health care. The smartest guys in the room have to work together and they need to take back their natural position as Leaders!

Stay tuned for more Todd's Tips!

— New Coding Tools —
Inpatient Coding Calculator!

The Inpatient E/M Coding Calculator is a resource designed to assist providers/coders/billers with appropriate code selection for evaluation and management services in the inpatient setting, which includes initial and subsequent inpatient care, initial and subsequent observation care, critical care services, and inpatient consultation care. This tool is a simplified version of the information provided in the 1995 and 1997 evaluation and management coding and documentation guidelines and can be used as a guide to understanding these requirements.

For more information, CLICK HERE to visit our Online Store.

Codes Of The Week


— Carpal tunnel syndrome, right
upper limb

— Carpal tunnel syndrome, left
upper limb

— Occupational exposure to other
risk factors

Other physical
and mental strain
related to work

Health care provider office as the place of occurrence of the external cause

RT Welter & Associates, Inc. is a proud member of the Colorado ICD–10 Training Coalition.