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Medicare Compliance & Reimbursement
Medicare Compliance & Reimbursement
Medicare Compliance & Reimbursement - 2024; Volume 50, Number 18
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...
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Medicare Tips:
Sharpen Your Medicare Signature Knowledge
Resolving your questionable signatures prior to claim submission is key. In your medica...
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Surgery Spotlight:
Help the Slipper Fit by Coding Cinderella Surgeries Correctly
Whether for cosmetic or therapeutic purposes, these procedures can prove essential. Cin...
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FAQ:
Get the Answers to Your Frequently Asked Modifier 24 Questions
Remember, not all postoperative services warrant using modifier 24. Have you used modifi...
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Reader Questions:
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 17
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...
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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...
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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 ...
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Reimbursement:
Know These 5 Things, Create Correct, Clean CRNA Claims
Is it supervision, medical direction, or non-medically directed? A certified registered ...
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Reader Questions:
Stay Away From This Conscious Sedation Scenario
Question: Our internal medicine doctors want the anesthesiologists to set up a system...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 16
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...
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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...
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HIPAA:
Examine These 3 Cases, Stay Safe from HIPAA Violations
Avoid the fate of these healthcare entities with solid training and compliance strategies...
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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...
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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...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 15
MPFS:
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Servic...
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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...
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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...
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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...
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Reader Questions:
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says we...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 14
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...
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Compliance:
Prepare for Proper Preventive Service Coding
Review the requirements of MWVs and AWVs. Regular checkups for patients is a given in an...
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Best Practices:
Dissect Your Workflow to Streamline Operations
Hint: Patient satisfaction is all about setting expectations. In a medical practice, or...
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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...
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Reader Questions:
Patients May Need to Choose Between Benefit Programs
Question: One of our patients mentioned to a nurse that they were receiving continuin...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 13
Fraud & Abuse:
Feds Focus On Physicians In June Enforcement
Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have n...
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Health IT:
Final Rule Outlines Info Blocking Disincentives For Quality Programs
Reg thwarts information blocking among MIPS clinicians, ACOs, and PI programs. No matter...
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Reimbursement:
Try These Tips For Boosting Financial Literacy
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ens...
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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...
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Reader Questions:
Know The Facts About Disclaimers On Records
Question: One of the physicians at our practice uses dictation software, and the vend...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 12
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...
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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...
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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 ...
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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...
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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...
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Reader Questions:
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber Ans...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 11
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...
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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...
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MIPS Quiz:
Test Yourself On The APM Performance Pathway
Understand what makes a provider a QP. Since CMS launched the Quality Payment Program (Q...
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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...
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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 ...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 10
Medicare Advantage:
New Rule Circumvents Beneficiary Data Sharing
Feds also aim to rein in brokers' avarice. With rising concerns that third-party brokers...
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MIPS Quiz:
Estimate Your MVP Prowess With This Test
Know the facts on submitting MVPs and Traditional MIPS simultaneously. Since reporting b...
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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 ...
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Toolkit:
To Notify Or Not To Notify — That Is The Question
Follow this decision tree to determine breach reporting. Practices often struggle with ...
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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...
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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...
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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...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 9
HIPAA:
New Rule Aims To Bolster Confidentiality Post-Dobbs
OCR adds updates that support privacy in reproductive healthcare. As legal wrangling cont...
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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...
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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...
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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 ...
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Industry Notes:
OCR Adds FAQs On Change Healthcare Incident
As the ransomware incident that clocked UnitedHealth Group's subsidiary Change Healthcare ...
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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...
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Reader Question:
Understand These NPI Basics For New Providers
Question: Our practice just hired a new provider. They have their medical license, bu...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 8
Payment Models:
CMS Continues To Focus On Quality And Savings
Recent payment models offer primary care, behavioral health expanded options. Not only d...
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MIPS Quiz:
Gauge Your Promoting Interoperability Savvy
Hint: Know the 4 PI objectives for PY 2024. If you think the Promoting Interoperability...
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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...
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Clip and Save:
Pocket This Primer On Informed Consent Forms
Pocket This Primer On Informed Consent Forms Critical: CMS revises interpretive guidance ...
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Reader Questions:
Understand The Rules On Reinstatement After Exclusion
Question: When an individual is excluded from participating in the Medicare program b...
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Reader Questions:
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures...
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Reader Questions:
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 7
Budget:
Find Out Top Factors In FY 2025 Budget Proposals
Funding for oversight and fraud enforcement are among the top budget requests. With 2024...
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Feds Finalize 2024 Funding
Tip: Understand these conversion factor changes already in effect. The feds finalized not...
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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...
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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...
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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...
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Reader Questions:
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely...
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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...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 6
Cybersecurity:
CMS Offers Support Amidst Change Healthcare Attack
Crucial: Connect with your MAC and other payers for additional advice. If you're scrambl...
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HIPAA:
OCR Warns Entities About Prioritizing Cybersecurity
Key stakeholders met to discuss ‘interconnectedness' of U.S. healthcare system. With r...
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MIPS Quiz:
Measure Your Cost Category Knowledge
Tip: Understand there's more than one type of measure in Cost. Mastering the Merit-Base...
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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...
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Pocket This ICD-10-CM Update For Asthma Coding
Changes are effective starting April 1. This past January, the Centers for Disease Contro...
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Industry Notes:
Review MAC Guidance Before Sending That AAP Request
If you plan on applying for the Change Healthcare/ Optum Payment Disruption (CHOPD) accele...
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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...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 5
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...
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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...
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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...
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Part B Coding Coach:
Tackle Thyroid Procedure Coding With These Tips
Check provider's wording to ensure understanding and claims success. When coding thyroid...
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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...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 4
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...
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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...
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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...
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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...
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Reader Question:
Understand These CMN Basics
Question: My billing supervisor erased data that the doctor wrote on a certificate of...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 3
No Surprises Act:
Feds’ Balance Billing Opus Continues To Evolve
Lawsuits, fee changes, and proposals abound. Since its inception, turmoil has surrounded ...
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EMTALA:
Feds Offer Clarity On Providers’ Obligations Under EMTALA
Patient inquiries cause HHS and CMS to offer public education resources. As the courts co...
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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 ...
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Industry Notes:
Review Which Codes Require Invoices, MAC Warns
Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) remin...
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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...
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Reader Questions:
Know the Difference Between EMRs and EHRs
Question: I've seen the acronyms EMR and EHR used interchangeably, but our IT manager...
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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 ...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 2
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...
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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...
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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...
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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...
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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...
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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
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 ...
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Reader Questions:
Understand How The Part D Appeals Process Works
Question: As a Medicare Part D provider prescriber, our practice was curious about t...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 1
Compliance:
CMS Reports Slight Error Rate Decrease For 2023
Documentation and medical necessity challenges top list of CERT woes. The feds made some ...
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Utilize This Handy CERT Tool
If you're stumped by CERT updates and are searching for all the latest and greatest on the...
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Here’s Why You Should Care About The CERT Report
Tip: Compare and contrast your internal issues against the national averages. Even if y...
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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...
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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...
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Industry Notes:
OCR Settles First Phishing Case
Caution: Analyze your risks, or pay the price. The benefits of technology to healthcare...
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Medicare Compliance & Reimbursement - 2024_October
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 ...
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Medicare Compliance & Reimbursement - 2024_October
Compliance:
Pocket This OIG-Centric Compliance Guidance
Build a solid compliance foundation so you're not caught unawares. People who have spent ...
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Medicare Compliance & Reimbursement - 2024_October
Medicare Regulations:
Pay Attention to Medicare POS Intricacies
Question: My provider sees Medicare beneficiaries in other facilities outside our off...
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Medicare Compliance & Reimbursement - 2024_October
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...
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Medicare Compliance & Reimbursement - 2024_October
Compliance:
Know What Counts as PHI
Question: I want to be able to explain protected health information (PHI) to onboarding co...
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Medicare Compliance & Reimbursement - 2024_October
Medicare Regulations:
Remember SDOH Assessment Responsibilities
Question: When exactly do we need to perform and report social determinants of health (SDO...
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Medicare Compliance & Reimbursement - 2024_November
Medicare Regulations:
Respond to CERT Requests Appropriately
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi...
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Medicare Compliance & Reimbursement - 2024_November
Compliance:
Incorporate These 7 Elements Into Your Compliance Program, Part 1
Find out which innovative approaches can boost compliance across your organization. CJ Wo...
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Compliance:
Contact These Officers if an Auditor Appears
Question: I've heard of some federal or state agencies sending inspectors for unannounced ...
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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...
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