Medicare Compliance & Reimbursement
ICD-10-CM:
Identify Location, Site, Complications to Choose Correct Atherosclerosis Dx
Hint: You must know if the patient also has angina pectoris or not. Coding for atheroscl... Read more
Identify Location, Site, Complications to Choose Correct Atherosclerosis Dx
Hint: You must know if the patient also has angina pectoris or not. Coding for atheroscl... Read more
Medicare Tips:
Sharpen Your Medicare Signature Knowledge
Resolving your questionable signatures prior to claim submission is key. In your medica... Read more
Sharpen Your Medicare Signature Knowledge
Resolving your questionable signatures prior to claim submission is key. In your medica... Read more
Surgery Spotlight:
Help the Slipper Fit by Coding Cinderella Surgeries Correctly
Whether for cosmetic or therapeutic purposes, these procedures can prove essential. Cin... Read more
Help the Slipper Fit by Coding Cinderella Surgeries Correctly
Whether for cosmetic or therapeutic purposes, these procedures can prove essential. Cin... Read more
FAQ:
Get the Answers to Your Frequently Asked Modifier 24 Questions
Remember, not all postoperative services warrant using modifier 24. Have you used modifi... Read more
Get the Answers to Your Frequently Asked Modifier 24 Questions
Remember, not all postoperative services warrant using modifier 24. Have you used modifi... Read more
Reader Questions:
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and... Read more
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and... Read more
Home Health:
Say ‘Hello’ to 4 New SDOH Items That May Hit OASIS in 2027
Plus: CMS wants to tweak all-payer collection start date. You'll have four new outcome a... Read more
Say ‘Hello’ to 4 New SDOH Items That May Hit OASIS in 2027
Plus: CMS wants to tweak all-payer collection start date. You'll have four new outcome a... Read more
ICD-10 2025:
ICD-10 Makes Eating Disorders More Specific
Also, synovitis/tenosynovitis combo code expands. ICD-10 has released its list of new, re... Read more
ICD-10 Makes Eating Disorders More Specific
Also, synovitis/tenosynovitis combo code expands. ICD-10 has released its list of new, re... Read more
Modifier Madness:
4 Tips to Help You Differentiate Modifiers 76, 77
Repeat service, but 2 different providers? There's a modifier for that. Do you know what ... Read more
4 Tips to Help You Differentiate Modifiers 76, 77
Repeat service, but 2 different providers? There's a modifier for that. Do you know what ... Read more
Reimbursement:
Know These 5 Things, Create Correct, Clean CRNA Claims
Is it supervision, medical direction, or non-medically directed? A certified registered ... Read more
Know These 5 Things, Create Correct, Clean CRNA Claims
Is it supervision, medical direction, or non-medically directed? A certified registered ... Read more
Reader Questions:
Stay Away From This Conscious Sedation Scenario
Question: Our internal medicine doctors want the anesthesiologists to set up a system... Read more
Stay Away From This Conscious Sedation Scenario
Question: Our internal medicine doctors want the anesthesiologists to set up a system... Read more
Compliance:
Review This False Claims Act Case, Learn How to Avoid Big Fines
Strengthen your understanding of MDM guidelines. As you may know, the Department of Just... Read more
Review This False Claims Act Case, Learn How to Avoid Big Fines
Strengthen your understanding of MDM guidelines. As you may know, the Department of Just... Read more
Billing:
Know These 7 Myths and 1 Truth About Fee-for-Time Billing
Prep now for summer FFT fill-ins, previously called locum tenens. Summer vacations are s... Read more
Know These 7 Myths and 1 Truth About Fee-for-Time Billing
Prep now for summer FFT fill-ins, previously called locum tenens. Summer vacations are s... Read more
HIPAA:
Examine These 3 Cases, Stay Safe from HIPAA Violations
Avoid the fate of these healthcare entities with solid training and compliance strategies... Read more
Examine These 3 Cases, Stay Safe from HIPAA Violations
Avoid the fate of these healthcare entities with solid training and compliance strategies... Read more
Telehealth:
Keep Up With These Changes to Post-PHE Telehealth
And get ready for telehealth codes to change again in 2025. During her HEALTHCON 2024 pre... Read more
Keep Up With These Changes to Post-PHE Telehealth
And get ready for telehealth codes to change again in 2025. During her HEALTHCON 2024 pre... Read more
Reader Questions:
Avoid Double Billing for Unattended Sleep Studies
Question: Can we bill G0399 and 95806-26 together on the same claim? One of our provi... Read more
Avoid Double Billing for Unattended Sleep Studies
Question: Can we bill G0399 and 95806-26 together on the same claim? One of our provi... Read more
MPFS:
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Servic... Read more
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Servic... Read more
Reimbursement:
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim t... Read more
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim t... Read more
Documentation:
Address These Key Fields, Complete ABNs With Ease
Don't forget that every ABN form must be one single page. As every practice is aware, co... Read more
Address These Key Fields, Complete ABNs With Ease
Don't forget that every ABN form must be one single page. As every practice is aware, co... Read more
News You Can Use:
Find Out What RCM Staff Learned From the Change Healthcare Outage
Learn how long paper-based claims take to process. When cyberthreat actors deployed a ra... Read more
Find Out What RCM Staff Learned From the Change Healthcare Outage
Learn how long paper-based claims take to process. When cyberthreat actors deployed a ra... Read more
Reader Questions:
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says we... Read more
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says we... Read more
ICD-10 2025:
Know What 2025 Has in Store for Oncology ICD-10 Coding
And know why the changes are going to matter for Medicare billing. On October 1, 2024, th... Read more
Know What 2025 Has in Store for Oncology ICD-10 Coding
And know why the changes are going to matter for Medicare billing. On October 1, 2024, th... Read more
Compliance:
Prepare for Proper Preventive Service Coding
Review the requirements of MWVs and AWVs. Regular checkups for patients is a given in an... Read more
Prepare for Proper Preventive Service Coding
Review the requirements of MWVs and AWVs. Regular checkups for patients is a given in an... Read more
Best Practices:
Dissect Your Workflow to Streamline Operations
Hint: Patient satisfaction is all about setting expectations. In a medical practice, or... Read more
Dissect Your Workflow to Streamline Operations
Hint: Patient satisfaction is all about setting expectations. In a medical practice, or... Read more
ICD-10 2025:
Codes for Epilepsy, Disc Degeneration Highlight New Additions
Do you know what KCNQ2-related epilepsy is? ICD-10 just settled on its list of new, revis... Read more
Codes for Epilepsy, Disc Degeneration Highlight New Additions
Do you know what KCNQ2-related epilepsy is? ICD-10 just settled on its list of new, revis... Read more
Reader Questions:
Patients May Need to Choose Between Benefit Programs
Question: One of our patients mentioned to a nurse that they were receiving continuin... Read more
Patients May Need to Choose Between Benefit Programs
Question: One of our patients mentioned to a nurse that they were receiving continuin... Read more
Fraud & Abuse:
Feds Focus On Physicians In June Enforcement
Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have n... Read more
Feds Focus On Physicians In June Enforcement
Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have n... Read more
Health IT:
Final Rule Outlines Info Blocking Disincentives For Quality Programs
Reg thwarts information blocking among MIPS clinicians, ACOs, and PI programs. No matter... Read more
Final Rule Outlines Info Blocking Disincentives For Quality Programs
Reg thwarts information blocking among MIPS clinicians, ACOs, and PI programs. No matter... Read more
Reimbursement:
Try These Tips For Boosting Financial Literacy
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ens... Read more
Try These Tips For Boosting Financial Literacy
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ens... Read more
Part B Coding Coach:
Pocket 3 Handy Q&As; On Allergy Testing Coding
See how to report and bill different supply scenarios. Green grass, blossoming trees, an... Read more
Pocket 3 Handy Q&As; On Allergy Testing Coding
See how to report and bill different supply scenarios. Green grass, blossoming trees, an... Read more
Reader Questions:
Know The Facts About Disclaimers On Records
Question: One of the physicians at our practice uses dictation software, and the vend... Read more
Know The Facts About Disclaimers On Records
Question: One of the physicians at our practice uses dictation software, and the vend... Read more
Enforcement:
OIG Maintains Spotlight On Managed Care Mayhem
Latest report has a new look and offers insight into the agency's top targets. Since 2022... Read more
OIG Maintains Spotlight On Managed Care Mayhem
Latest report has a new look and offers insight into the agency's top targets. Since 2022... Read more
Practice Safety:
Keep Your Staff, Patients Safe With These Lab Precautions
Hint: Follow OSHA, but also have policies in place customized to your practice. Every la... Read more
Keep Your Staff, Patients Safe With These Lab Precautions
Hint: Follow OSHA, but also have policies in place customized to your practice. Every la... Read more
Part B Coding Coach:
Unravel Place of Service, Site and Level of Care
Get expert guidance on avoiding denials. Keeping up with all the different ways to deal ... Read more
Unravel Place of Service, Site and Level of Care
Get expert guidance on avoiding denials. Keeping up with all the different ways to deal ... Read more
Reader Questions:
Heed This Insight On Documentation Requests For CERT Reviews
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi... Read more
Heed This Insight On Documentation Requests For CERT Reviews
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi... Read more
Reader Questions:
Know The Facts On How MedPAC Impacts Your Bottom Line
Question: I've seen a lot of “MedPAC says this” and “MedPAC says that,” but I... Read more
Know The Facts On How MedPAC Impacts Your Bottom Line
Question: I've seen a lot of “MedPAC says this” and “MedPAC says that,” but I... Read more
Reader Questions:
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber Ans... Read more
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber Ans... Read more
Targeted Probe And Educate:
Establish Practice Protocols For Addressing A TPE Audit
Hint: Look at your MAC's focus to troubleshoot internal issues. Whether you've already s... Read more
Establish Practice Protocols For Addressing A TPE Audit
Hint: Look at your MAC's focus to troubleshoot internal issues. Whether you've already s... Read more
EMTALA Update:
Find Out The Latest On New EMTALA Violation Complaint Option
Feds continue to protect patients' access to emergency care. With EMTALA violations on th... Read more
Find Out The Latest On New EMTALA Violation Complaint Option
Feds continue to protect patients' access to emergency care. With EMTALA violations on th... Read more
MIPS Quiz:
Test Yourself On The APM Performance Pathway
Understand what makes a provider a QP. Since CMS launched the Quality Payment Program (Q... Read more
Test Yourself On The APM Performance Pathway
Understand what makes a provider a QP. Since CMS launched the Quality Payment Program (Q... Read more
Part B Coding Coach:
Know the Flow of Urodynamic Test Coding
Dodge claim errors by spotting the differences between these tests. When a provider cond... Read more
Know the Flow of Urodynamic Test Coding
Dodge claim errors by spotting the differences between these tests. When a provider cond... Read more
Reader Questions:
Focus On The Facts When Hiring HIPAA Audit Assistance
Question: Our large, primary care practice takes HIPAA very seriously, and we do our ... Read more
Focus On The Facts When Hiring HIPAA Audit Assistance
Question: Our large, primary care practice takes HIPAA very seriously, and we do our ... Read more
Medicare Advantage:
New Rule Circumvents Beneficiary Data Sharing
Feds also aim to rein in brokers' avarice. With rising concerns that third-party brokers... Read more
New Rule Circumvents Beneficiary Data Sharing
Feds also aim to rein in brokers' avarice. With rising concerns that third-party brokers... Read more
MIPS Quiz:
Estimate Your MVP Prowess With This Test
Know the facts on submitting MVPs and Traditional MIPS simultaneously. Since reporting b... Read more
Estimate Your MVP Prowess With This Test
Know the facts on submitting MVPs and Traditional MIPS simultaneously. Since reporting b... Read more
Part B Coding Coach:
Avoid These 5 Modifier 59 Errors To Keep Pay Flowing
Plus: Find out the 2024 news that changes one modifier 59 rule. What would you do if 40 ... Read more
Avoid These 5 Modifier 59 Errors To Keep Pay Flowing
Plus: Find out the 2024 news that changes one modifier 59 rule. What would you do if 40 ... Read more
Toolkit:
To Notify Or Not To Notify — That Is The Question
Follow this decision tree to determine breach reporting. Practices often struggle with ... Read more
To Notify Or Not To Notify — That Is The Question
Follow this decision tree to determine breach reporting. Practices often struggle with ... Read more
Industry Notes:
QPP 2024 Hardship Applications Are Now Open
If you're struggling with meeting the demands of the Quality Payment Program (QPP), you ma... Read more
QPP 2024 Hardship Applications Are Now Open
If you're struggling with meeting the demands of the Quality Payment Program (QPP), you ma... Read more
Industry Notes:
The Pre-Presidential Election Rule Rush Is In Full Flow
If you feel like federal regulations are raining down like never before, you're probably r... Read more
The Pre-Presidential Election Rule Rush Is In Full Flow
If you feel like federal regulations are raining down like never before, you're probably r... Read more
Reader Questions:
Know What Traditional Medicare Won’t Pay Extra For
Question: I thought Medicare does not pay extra for physical status modifiers or qual... Read more
Know What Traditional Medicare Won’t Pay Extra For
Question: I thought Medicare does not pay extra for physical status modifiers or qual... Read more
HIPAA:
New Rule Aims To Bolster Confidentiality Post-Dobbs
OCR adds updates that support privacy in reproductive healthcare. As legal wrangling cont... Read more
New Rule Aims To Bolster Confidentiality Post-Dobbs
OCR adds updates that support privacy in reproductive healthcare. As legal wrangling cont... Read more
MIPS Quiz:
Assess Your Command Of The Quality Performance Category
Figure out what the data threshold is for PY 2024. The key to avoiding penalties and max... Read more
Assess Your Command Of The Quality Performance Category
Figure out what the data threshold is for PY 2024. The key to avoiding penalties and max... Read more
Part B Coding Coach:
Use These 6 Tips To Code Hearing Tests Successfully
Start by knowing what's included in an E/M visit. If your practice includes an audiologi... Read more
Use These 6 Tips To Code Hearing Tests Successfully
Start by knowing what's included in an E/M visit. If your practice includes an audiologi... Read more
Industry Notes:
UnitedHealth-Change Healthcare Cyberattack Damage Continues, Even After Ransom Was Paid
If you were wondering whether UnitedHealth Group (UHG) paid the hackers who attacked its ... Read more
UnitedHealth-Change Healthcare Cyberattack Damage Continues, Even After Ransom Was Paid
If you were wondering whether UnitedHealth Group (UHG) paid the hackers who attacked its ... Read more
Industry Notes:
OCR Adds FAQs On Change Healthcare Incident
As the ransomware incident that clocked UnitedHealth Group's subsidiary Change Healthcare ... Read more
OCR Adds FAQs On Change Healthcare Incident
As the ransomware incident that clocked UnitedHealth Group's subsidiary Change Healthcare ... Read more
Industry Notes:
OIG Report Points Out PRF Overpayment Issue … Again
If you thought the HHS Office of Inspector General's (OIG) scrutiny of CARES Act Provider... Read more
OIG Report Points Out PRF Overpayment Issue … Again
If you thought the HHS Office of Inspector General's (OIG) scrutiny of CARES Act Provider... Read more
Reader Question:
Understand These NPI Basics For New Providers
Question: Our practice just hired a new provider. They have their medical license, bu... Read more
Understand These NPI Basics For New Providers
Question: Our practice just hired a new provider. They have their medical license, bu... Read more
Payment Models:
CMS Continues To Focus On Quality And Savings
Recent payment models offer primary care, behavioral health expanded options. Not only d... Read more
CMS Continues To Focus On Quality And Savings
Recent payment models offer primary care, behavioral health expanded options. Not only d... Read more
MIPS Quiz:
Gauge Your Promoting Interoperability Savvy
Hint: Know the 4 PI objectives for PY 2024. If you think the Promoting Interoperability... Read more
Gauge Your Promoting Interoperability Savvy
Hint: Know the 4 PI objectives for PY 2024. If you think the Promoting Interoperability... Read more
Part B Coding Coach:
+99459: 5 FAQs Clarify How to Use This Expense Only Code
Here's what your physician's documentation needs to include. Since January 1, you can us... Read more
+99459: 5 FAQs Clarify How to Use This Expense Only Code
Here's what your physician's documentation needs to include. Since January 1, you can us... Read more
Clip and Save:
Pocket This Primer On Informed Consent Forms
Pocket This Primer On Informed Consent Forms Critical: CMS revises interpretive guidance ... Read more
Pocket This Primer On Informed Consent Forms
Pocket This Primer On Informed Consent Forms Critical: CMS revises interpretive guidance ... Read more
Reader Questions:
Understand The Rules On Reinstatement After Exclusion
Question: When an individual is excluded from participating in the Medicare program b... Read more
Understand The Rules On Reinstatement After Exclusion
Question: When an individual is excluded from participating in the Medicare program b... Read more
Reader Questions:
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures... Read more
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures... Read more
Reader Questions:
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Budget:
Find Out Top Factors In FY 2025 Budget Proposals
Funding for oversight and fraud enforcement are among the top budget requests. With 2024... Read more
Find Out Top Factors In FY 2025 Budget Proposals
Funding for oversight and fraud enforcement are among the top budget requests. With 2024... Read more
Feds Finalize 2024 Funding
Tip: Understand these conversion factor changes already in effect. The feds finalized not... Read more
Tip: Understand these conversion factor changes already in effect. The feds finalized not... Read more
MIPS Quiz:
Evaluate How Well You Know The MIPS Improvement Activities
Tip: Understand what you need to get full credit in this performance category. For many... Read more
Evaluate How Well You Know The MIPS Improvement Activities
Tip: Understand what you need to get full credit in this performance category. For many... Read more
Part B Coding Coach:
Make Radiation Treatment Management Codes Count
But use this one code sparingly, if ever. There are many moving parts to radiation treatm... Read more
Make Radiation Treatment Management Codes Count
But use this one code sparingly, if ever. There are many moving parts to radiation treatm... Read more
Industry Notes:
Feds Offer Tools For Providers Affected By Cyberattack
If your practice is one of the many affected by the cyberattack against Change Healthcare... Read more
Feds Offer Tools For Providers Affected By Cyberattack
If your practice is one of the many affected by the cyberattack against Change Healthcare... Read more
Reader Questions:
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely... Read more
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely... Read more
Reader Questions:
Make Sure Your Health Apps And Wearables Are Compliant
Question: We use wearable devices and health apps to remotely monitor our patients wh... Read more
Make Sure Your Health Apps And Wearables Are Compliant
Question: We use wearable devices and health apps to remotely monitor our patients wh... Read more
Cybersecurity:
CMS Offers Support Amidst Change Healthcare Attack
Crucial: Connect with your MAC and other payers for additional advice. If you're scrambl... Read more
CMS Offers Support Amidst Change Healthcare Attack
Crucial: Connect with your MAC and other payers for additional advice. If you're scrambl... Read more
HIPAA:
OCR Warns Entities About Prioritizing Cybersecurity
Key stakeholders met to discuss ‘interconnectedness' of U.S. healthcare system. With r... Read more
OCR Warns Entities About Prioritizing Cybersecurity
Key stakeholders met to discuss ‘interconnectedness' of U.S. healthcare system. With r... Read more
MIPS Quiz:
Measure Your Cost Category Knowledge
Tip: Understand there's more than one type of measure in Cost. Mastering the Merit-Base... Read more
Measure Your Cost Category Knowledge
Tip: Understand there's more than one type of measure in Cost. Mastering the Merit-Base... Read more
Part B Coding Coach:
Debunk These 3 Common Allergy Coding Myths
Remember to report the cause of asthma exacerbation. With allergy season in full swing, y... Read more
Debunk These 3 Common Allergy Coding Myths
Remember to report the cause of asthma exacerbation. With allergy season in full swing, y... Read more
Pocket This ICD-10-CM Update For Asthma Coding
Changes are effective starting April 1. This past January, the Centers for Disease Contro... Read more
Changes are effective starting April 1. This past January, the Centers for Disease Contro... Read more
Industry Notes:
Review MAC Guidance Before Sending That AAP Request
If you plan on applying for the Change Healthcare/ Optum Payment Disruption (CHOPD) accele... Read more
Review MAC Guidance Before Sending That AAP Request
If you plan on applying for the Change Healthcare/ Optum Payment Disruption (CHOPD) accele... Read more
Industry Notes:
CMS Reopens 2023 MIPS EUC Application
If you've been impacted by the Change Healthcare cyberattack and you can prove it's affect... Read more
CMS Reopens 2023 MIPS EUC Application
If you've been impacted by the Change Healthcare cyberattack and you can prove it's affect... Read more
Prior Authorization:
Final Rule Aims To Improve Interoperability And Access To Care
Plus: Feds finalize new API requirements and a MIPS measure, too. After the pandemic reve... Read more
Final Rule Aims To Improve Interoperability And Access To Care
Plus: Feds finalize new API requirements and a MIPS measure, too. After the pandemic reve... Read more
Fraud & Abuse:
Feds Focus On Physicians In February Enforcement
Caution: The 2023 FCA settlement numbers may shock you. Per usual, the feds are off and r... Read more
Feds Focus On Physicians In February Enforcement
Caution: The 2023 FCA settlement numbers may shock you. Per usual, the feds are off and r... Read more
MIPS Quiz:
Test Your MIPS Smarts With This Quiz On The Basics
Tip: Know what your participation options include. Even though the Quality Payment Progr... Read more
Test Your MIPS Smarts With This Quiz On The Basics
Tip: Know what your participation options include. Even though the Quality Payment Progr... Read more
Part B Coding Coach:
Tackle Thyroid Procedure Coding With These Tips
Check provider's wording to ensure understanding and claims success. When coding thyroid... Read more
Tackle Thyroid Procedure Coding With These Tips
Check provider's wording to ensure understanding and claims success. When coding thyroid... Read more
Industry Notes:
Ensure Your Team Knows The Rules On Recoupment
Keep staff in the loop to avoid issues. Educating your personnel on how recoupment reques... Read more
Ensure Your Team Knows The Rules On Recoupment
Keep staff in the loop to avoid issues. Educating your personnel on how recoupment reques... Read more
HIPAA Round-Up:
Feds Follow Through With Final SUD Rule
Plus: See the latest settlement and regulatory updates. Even though we're only a few mon... Read more
Feds Follow Through With Final SUD Rule
Plus: See the latest settlement and regulatory updates. Even though we're only a few mon... Read more
Artificial Intelligence:
Discover How CMS Is Harnessing AI
Check out the agency's AI Playbook and what's ahead with emerging tech. As AI evolves and... Read more
Discover How CMS Is Harnessing AI
Check out the agency's AI Playbook and what's ahead with emerging tech. As AI evolves and... Read more
Expect AI To Be An Enforcement Tool — And Target
Experts warn about the perils of too much dependency on AI. You may find that the pros ou... Read more
Experts warn about the perils of too much dependency on AI. You may find that the pros ou... Read more
Part B Coding Coach:
Strengthen Your Modifier QW Savvy With These Steps
Don't forget to check the CLIA list when submitting a new lab test — every time. Whil... Read more
Strengthen Your Modifier QW Savvy With These Steps
Don't forget to check the CLIA list when submitting a new lab test — every time. Whil... Read more
Reader Question:
Understand These CMN Basics
Question: My billing supervisor erased data that the doctor wrote on a certificate of... Read more
Understand These CMN Basics
Question: My billing supervisor erased data that the doctor wrote on a certificate of... Read more
No Surprises Act:
Feds’ Balance Billing Opus Continues To Evolve
Lawsuits, fee changes, and proposals abound. Since its inception, turmoil has surrounded ... Read more
Feds’ Balance Billing Opus Continues To Evolve
Lawsuits, fee changes, and proposals abound. Since its inception, turmoil has surrounded ... Read more
EMTALA:
Feds Offer Clarity On Providers’ Obligations Under EMTALA
Patient inquiries cause HHS and CMS to offer public education resources. As the courts co... Read more
Feds Offer Clarity On Providers’ Obligations Under EMTALA
Patient inquiries cause HHS and CMS to offer public education resources. As the courts co... Read more
Part B Coding Coach:
Bolster Colonoscopy Pre-Op Smarts With These Tips
Hint: Don't forget how comorbid conditions can impact pre-op E/M coding. Whether you're ... Read more
Bolster Colonoscopy Pre-Op Smarts With These Tips
Hint: Don't forget how comorbid conditions can impact pre-op E/M coding. Whether you're ... Read more
Industry Notes:
Review Which Codes Require Invoices, MAC Warns
Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) remin... Read more
Review Which Codes Require Invoices, MAC Warns
Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) remin... Read more
Industry Notes:
Compare Site Now Includes Physicians’ And Clinicians’ Procedure Volume Data
If you want to find utilization data on the number of procedures clinicians and physicians... Read more
Compare Site Now Includes Physicians’ And Clinicians’ Procedure Volume Data
If you want to find utilization data on the number of procedures clinicians and physicians... Read more
Reader Questions:
Know the Difference Between EMRs and EHRs
Question: I've seen the acronyms EMR and EHR used interchangeably, but our IT manager... Read more
Know the Difference Between EMRs and EHRs
Question: I've seen the acronyms EMR and EHR used interchangeably, but our IT manager... Read more
Reader Questions:
Consider This Insight On Qualifying for Home Visit
Question: One of the providers at our practice wants to bill 99350 when performing a ... Read more
Consider This Insight On Qualifying for Home Visit
Question: One of the providers at our practice wants to bill 99350 when performing a ... Read more
Medicare Advantage:
Bolster Managed Care Smarts With This Insight
Caution: Fix MA faux pas before OIG intervenes. With managed care on the HHS Office of I... Read more
Bolster Managed Care Smarts With This Insight
Caution: Fix MA faux pas before OIG intervenes. With managed care on the HHS Office of I... Read more
Part B Coding Coach:
Pocket This Assistant At Surgery Modifier Primer
Hint: Do not report modifiers 80 and AS together. An assistant surgeon may be necessary... Read more
Pocket This Assistant At Surgery Modifier Primer
Hint: Do not report modifiers 80 and AS together. An assistant surgeon may be necessary... Read more
Health IT:
Know The 10 Agencies That Impact Your Health IT
Get the scoop from transactions to privacy to enforcement. One thing is certain in feder... Read more
Know The 10 Agencies That Impact Your Health IT
Get the scoop from transactions to privacy to enforcement. One thing is certain in feder... Read more
Industry Notes:
See The Latest Provider Enrollment Fee Increase
It's time to tighten your belt again. The costs of Medicare provider enrollment went up fo... Read more
See The Latest Provider Enrollment Fee Increase
It's time to tighten your belt again. The costs of Medicare provider enrollment went up fo... Read more
Industry Notes:
Submit PRF Attestations For RP 6 ASAP
If you received COVID-19 Provider Relief Fund (PRF) payments in the last half of 2022, the... Read more
Submit PRF Attestations For RP 6 ASAP
If you received COVID-19 Provider Relief Fund (PRF) payments in the last half of 2022, the... Read more
Industry Notes:
Add These QPP Policy Deadlines To Your Calendar
If you want to offer your two cents on specific Quality Payment Program (QPP) policies for... Read more
Add These QPP Policy Deadlines To Your Calendar
If you want to offer your two cents on specific Quality Payment Program (QPP) policies for... Read more
Reader Question:
Get The Facts On EHR Standards For MIPS 2024
Question: We're a little confused by the updated information on EHR requirements for ... Read more
Get The Facts On EHR Standards For MIPS 2024
Question: We're a little confused by the updated information on EHR requirements for ... Read more
Reader Questions:
Understand How The Part D Appeals Process Works
Question: As a Medicare Part D provider prescriber, our practice was curious about t... Read more
Understand How The Part D Appeals Process Works
Question: As a Medicare Part D provider prescriber, our practice was curious about t... Read more
Compliance:
CMS Reports Slight Error Rate Decrease For 2023
Documentation and medical necessity challenges top list of CERT woes. The feds made some ... Read more
CMS Reports Slight Error Rate Decrease For 2023
Documentation and medical necessity challenges top list of CERT woes. The feds made some ... Read more
Utilize This Handy CERT Tool
If you're stumped by CERT updates and are searching for all the latest and greatest on the... Read more
If you're stumped by CERT updates and are searching for all the latest and greatest on the... Read more
Here’s Why You Should Care About The CERT Report
Tip: Compare and contrast your internal issues against the national averages. Even if y... Read more
Tip: Compare and contrast your internal issues against the national averages. Even if y... Read more
CERT Quiz:
Test Your Smarts On MACs’ Role In CERT Review Process
Hint: It's complicated. As a Medicare provider, you may be accustomed to checking with th... Read more
Test Your Smarts On MACs’ Role In CERT Review Process
Hint: It's complicated. As a Medicare provider, you may be accustomed to checking with th... Read more
Part B Coding Coach:
Follow 3 Steps To Bolster Bleeding Control Reporting
Hint: Don't forget to review NCCI policies. During a surgical procedure or in the midst o... Read more
Follow 3 Steps To Bolster Bleeding Control Reporting
Hint: Don't forget to review NCCI policies. During a surgical procedure or in the midst o... Read more
Industry Notes:
OCR Settles First Phishing Case
Caution: Analyze your risks, or pay the price. The benefits of technology to healthcare... Read more
OCR Settles First Phishing Case
Caution: Analyze your risks, or pay the price. The benefits of technology to healthcare... Read more
Medicare Regulations:
Pocket These Tips for Documenting Mental Health Services for Medicare Beneficiaries
Explore how Medicare is expanding and reimbursing behavioral health services. On January ... Read more
Pocket These Tips for Documenting Mental Health Services for Medicare Beneficiaries
Explore how Medicare is expanding and reimbursing behavioral health services. On January ... Read more
Compliance:
Pocket This OIG-Centric Compliance Guidance
Build a solid compliance foundation so you're not caught unawares. People who have spent ... Read more
Pocket This OIG-Centric Compliance Guidance
Build a solid compliance foundation so you're not caught unawares. People who have spent ... Read more
Medicare Regulations:
Pay Attention to Medicare POS Intricacies
Question: My provider sees Medicare beneficiaries in other facilities outside our off... Read more
Pay Attention to Medicare POS Intricacies
Question: My provider sees Medicare beneficiaries in other facilities outside our off... Read more
Compliance:
Understand ‘CIA’ As it Pertains to Healthcare
Question: I'm new to the front desk of a medical practice and heard a colleague mention th... Read more
Understand ‘CIA’ As it Pertains to Healthcare
Question: I'm new to the front desk of a medical practice and heard a colleague mention th... Read more
Compliance:
Know What Counts as PHI
Question: I want to be able to explain protected health information (PHI) to onboarding co... Read more
Know What Counts as PHI
Question: I want to be able to explain protected health information (PHI) to onboarding co... Read more
Medicare Regulations:
Remember SDOH Assessment Responsibilities
Question: When exactly do we need to perform and report social determinants of health (SDO... Read more
Remember SDOH Assessment Responsibilities
Question: When exactly do we need to perform and report social determinants of health (SDO... Read more
Medicare Regulations:
Respond to CERT Requests Appropriately
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi... Read more
Respond to CERT Requests Appropriately
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi... Read more
Compliance:
Incorporate These 7 Elements Into Your Compliance Program, Part 1
Find out which innovative approaches can boost compliance across your organization. CJ Wo... Read more
Incorporate These 7 Elements Into Your Compliance Program, Part 1
Find out which innovative approaches can boost compliance across your organization. CJ Wo... Read more
Compliance:
Contact These Officers if an Auditor Appears
Question: I've heard of some federal or state agencies sending inspectors for unannounced ... Read more
Contact These Officers if an Auditor Appears
Question: I've heard of some federal or state agencies sending inspectors for unannounced ... Read more
Compliance:
Lean on Provider Education, for Individuals or for Everyone
Question: How do I respectfully keep on top of a provider whose documentation about the ti... Read more
Lean on Provider Education, for Individuals or for Everyone
Question: How do I respectfully keep on top of a provider whose documentation about the ti... Read more
Medicare Regulations:
View the Highlights and Lowlights of the 2025 MPFS
Stay ahead of numerous telehealth revisions. On Nov. 5, 2024, the Centers for Medicare &a... Read more
View the Highlights and Lowlights of the 2025 MPFS
Stay ahead of numerous telehealth revisions. On Nov. 5, 2024, the Centers for Medicare &a... Read more
Compliance:
Find 4 More Crucial Elements to Boost Your Compliance Program
Tip: A log of issues is a means of troubleshooting — and insurance. CJ Wolf, MD, M.Ed.,... Read more
Find 4 More Crucial Elements to Boost Your Compliance Program
Tip: A log of issues is a means of troubleshooting — and insurance. CJ Wolf, MD, M.Ed.,... Read more
Medicare Regulations:
Explore Whether Your Medicare Claims are at Risk
Federal agencies uncovered double payments after providers billed Medicare and the VA. A ... Read more
Explore Whether Your Medicare Claims are at Risk
Federal agencies uncovered double payments after providers billed Medicare and the VA. A ... Read more
Medicare Regulations:
Don’t Use an ABN to Counteract a MUE
Question: Is it ever appropriate to fill out an advance beneficiary notice (ABN) form for ... Read more
Don’t Use an ABN to Counteract a MUE
Question: Is it ever appropriate to fill out an advance beneficiary notice (ABN) form for ... Read more
Medicare Regulations:
Find Out Which Beneficiary Counseling Situations May Be Reimbursed
Question: Which Medicare beneficiaries qualify for tobacco cessation counseling? Ala... Read more
Find Out Which Beneficiary Counseling Situations May Be Reimbursed
Question: Which Medicare beneficiaries qualify for tobacco cessation counseling? Ala... Read more
Compliance:
Avoid FCA Problems by Coding What’s Documented
Question: I'm a new hire at a practice that primarily sees patients concerned they have at... Read more
Avoid FCA Problems by Coding What’s Documented
Question: I'm a new hire at a practice that primarily sees patients concerned they have at... Read more