Advanced Search

Medicare Compliance & Reimbursement

PHYSICIANS:
You've Escaped Medicare Payment Cuts--For The Moment
Senate version of bill looks better than House version.Congress moved at the very last min... Read more
ENROLLMENT:
Why Carriers Are Holding Tens Of Thousands Of Applications In Backlog
Revalidate your enrollment information now, to avoid hold-ups later.A new clog in the Medi... Read more
HOSPITALS:
'Hospital Compare' Performance Measures Don't Reflect Changes In Your Mortality Rates
CMS may need to go back to the drawing board for your quality measures, study says.The Cen... Read more
CARDIOVASCULAR SURGERY CODING:
A Modifier Won't Rescue You From Cardiovascular-Code Edits
New codes 33254-33256 could have strings attached.Even before you break out your new cardi... Read more
HIPAA COMPLIANCE:
Employers Could Be At Risk When They Collect Genetic Data From Employees
Study shows genetic info lacks privacy protections.Knowing which rules to follow when it c... Read more
FRAUD & ABUSE:
Beware--OIG Is Looking For Underdosing, Falsifying Records
OIG finds lots of improper billing and fraud with physical therapy services.Watch out: You... Read more
LEGISLATION:
How You Can Start 2007 With No Change To Your Reimbursement
Get ready for pay-for-reporting, medication quality standards.Good news: Congress acted at... Read more
HOSPITALS ~ CMS Slaps A Fresh Coat Of Paint On 'Outdated And Unduly Burdensome' Hospital Regs
Medicare changes guidelines for history and physical examination, among others. The Center... Read more
NPIs ~ Don't Leave Your NPI Application Until The Last Minute
Get all your ducks in a row when you apply for an NPI. If you've been waiting to get a nat... Read more
MUEs ~ Anatomic Edits Will Be The First To Take Effect In January
The 'unlikely' will definitely happen -- will you be ready? Brace yourself: Beginning... Read more
MEDICARE ~ Why Medicare Advantage Is Costing Billions More Than Traditional FFS
Mandated extra MA payments may be dragging down the entire program. The federal government... Read more
NPIs ~ Contact Your Software Vendor Now To Make Sure You'll Be Up To Speed
Don't let out-of-date software keep you from using NPIs. A patch could keep your billing s... Read more
RADIOLOGISTS ~ How A Good Team Effort Between An SLP And A Radiologist Is Not A Bad Thing
Get straight answers to your MBS billing questions. You no longer have to trip over the Ce... Read more
INDUSTRY NOTES ~ Medicare, Medicaid Pay Out Nearly $10 Billion Each Year For Injuries
Plus: AMA has developed 151 quality measures for physicians. Injuries cost U.S. hospitals ... Read more
INDUSTRY NOTES ~ AMA Calls On Congress To Avert 5-Percent Cut Before It's Too Late
The American Medical Association (AMA) kept up its end of the bargain -- and now it's... Read more
IN OTHER NEWS
· The Recovery Audit Contractors (RACs) that the Centers for Medicare & Medicaid Serv... Read more
EMERGENCY MEDICINE ~ Good News:
Your ED E/Ms Will Be Worth More In 2007
CMS knocks down conversion factor, props up RVUs for ED E/Ms. Medicare recently firmed up ... Read more
SPECIAL REPORT ~ Part D Open Enrollment Begins -- But Doughnut Hole, High Drug Prices Still Plague Seniors
One organization offers tips on how your patients can save on drugs. Approximately 48 perc... Read more
PHYSICIANS ~ For Billing Consults, This Is Not The 'Sharing' Season
A consult shared is a problem doubled. False: You can have a nurse practitioner (NP) or ph... Read more
E/M CODING ~ Look For More Detailed Statements, Extra Elements When Reporting Code 99214
Beware of vague guidance from CMS regarding this code. You can't rely on the number of org... Read more
GAO ~ HHS Blames Medicare For Most Improper Payments
But Medicare does a better job of collecting documentation from providers. The federal gov... Read more
FRAUD & ABUSE ~ Physician Could Spend 20 Years In Prison For What He Did While On Vacation
Doctor pleads guilty to distributing controlled substances charge. A vacationing pain doct... Read more
INDUSTRY NOTES ~ Doctor Who Is Allegedly Anti-Birth Control To Head Up HHS' Family Planning Programs
Plus: AHRQ offers practical tips for hospitals to boost patient safety. President Bush and... Read more
INDUSTRY NOTES ~ Reducing Medical Errors In Hospitals -- Made Easy
Ensuring patient safety and decreasing errors are no doubt top priorities for U.S. hospita... Read more
MID-TERM ELECTIONS ~ SCHIP, Part D To Get Extra Attention From Democratic Majority In Congress
Many industry groups think the new Democratic Congress is a boon for health care. The pres... Read more
PHYSICIANS ~ Reforms For Your Medicare Payments Could Happen Late In New Congressional Session
Democratic landslide means Congress may let your payments slide. It could be March, or eve... Read more
REHAB THERAPISTS ~ You Could Lose Big Money In 2007 -- Unless Congress Steps In
New fee schedule and therapy caps spell bad news for your reimbursement. Not only will you... Read more
HOME HEALTH CARE ~ Medicare Managed Care Likely To Become Lawmakers' New Financing Pincushion
Democratic election victory good for home care. Home care providers may be out of the legi... Read more
REIMBURSEMENT ~ Some Specialties Reap Massive Pay Increases, Others Suffer
Women could lose out from the new practice expense payments. Some services will see drasti... Read more
PART B ~ You Can Obtain A DME Billing Number To Bill For Oral Medications
Don't throw away money for anti-emetic, immunosuppressive drugs. If you're confused about ... Read more
RADIATION THERAPY ~ Think You Can't Bill For Radiation Therapy Twice A Day? Think Again
Double your reimbursement by noting when radiation therapy is twice daily. The Centers for... Read more
INDUSTRY NOTES ~ Look Out For Dual Radiology Billing
Plus: Suppliers must go beyond CMN, court says. The Part B carriers are putting in place e... Read more
PHYSICIANS:
For You And Your Patients, Talk Isn't Cheap Anymore
But CMS will reduce your payments by 5 percent overall.There's good news and bad news for ... Read more
HOSPITALS:
You'll Get A Payment Increase In 2007, But Medicare Will Demand More Quality Reporting
CMS is concerned about the 12-percent jump in hospital outpatient expenditures.Although yo... Read more
HHAs:
Your Reimbursement Could Hang In The Balance On Election Night
How the elections may determine the fate of home care.Home health agencies (HHAs) shouldn'... Read more
PART D:
Industry Groups Argue Over Part D Doughnut Hole
Consumer group sees gap coverage for only generics as useless to seniors.After the Departm... Read more
GENERAL SURGERY:
Anatomic Location Is Now A Factor For Graft Preparation
New skin codes could fit you like a second skin.You could soon be reaping more reimburseme... Read more
CARDIOTHORACIC CODING:
Why CPT 2007 Makes Billing 33254-33256 Almost Impossible
Navigating new maze codes leaves coders right back where they started.You may have celebra... Read more
INDUSTRY NOTES:
CMS Can't See Coverage For Infrared Therapy
Plus:  HHAs will enjoy a bigger-than-expected payment boost.Medicare won't cover infr... Read more
NURSING HOMES:
CMS To Nursing Homes: You Must Install Sprinkler Systems, Or Else
New proposed rule goes beyond CMS' March 2005 smoke-alarm requirement.If you want to conti... Read more
SUPPLIERS:
Reimbursement Reductions May Compromise Your Patients' Access To Oxygen, PMDs
DME suppliers battle looming pay cuts.Two groups of stakeholders in the world of durable m... Read more
BILLING:
Make Sure Your Billing Software Is Ready To Handle These Changes
Get up to speed on the new CMS-1500 form.Just when you think you're prepared for the Natio... Read more
HIPAA TOOLKIT:
Why One Size Does Not Fit All Regarding Your HIPAA Sanction Methods
8 questions to ask when drafting HIPAA sanction policies.Have you recently taken a look at... Read more
SNFs:
Avoid Symptom Code When Specific Cause Of Altered Mental Status Is Known
New cognitive impairment, mental status codes enhance your coding accuracy.Two of the new ... Read more
INDUSTRY NOTES:
Carriers Will Consider All Diagnosis Codes On Medicare Claims
Plus:  Home care agency owner nabbed for defrauding Medicare of $40 million.The Cente... Read more
P4P:
Small Physician Practices--Get Ready For P4P Programs
CMS targets 800 practices in 4 states for its new demo.Encouraged by early results showing... Read more
PHYSICIANS:
Your Payment System Doesn't Account For Drug Discounts You Never See, MedPAC Says
You could receive pay boosts of up to 3-percent per year.If you took away all the mistakes... Read more
PART B:
Check Secondary Coverage Before Charging Patient For Preventive Services
Tip: Obtain a denial from Medicare so the claim can cross over.Myth: You can't bill for a ... Read more
PART D:
CMS Wants Your Opinion On Sharing Part D Claims Data
Proposed reg would release Part D claims data to federal agencies and researchers.A new pr... Read more
NPPs:
Don't Take Denials Lying Down--Contact CMS Now
Manual misprint leads to missed reimbursement for NPs.If you're seeing denials for nurse p... Read more
COMPLIANCE:
Watch Out--OIG Zeroes In On Incident-To Billing
Federal watchdog agency's work plan will keep it busy next year.The HHS Office of Inspecto... Read more
GENERAL SURGERY CODING:
You Can Stop Using An Unlisted Code For Gastric Electro Stimulation
But rectal mucosectomy may have become harder to bill.It looks as though surgeons can't bi... Read more
INDUSTRY NOTES:
CMS Looks To Continue Decreases In Improper Medicare Payments With Tough Oversight
Plus:  CPT 2007 has new codes for Moh's surgery.Medicare's detailed reviews of fee-fo... Read more
PHYSICIANS:
Some Republicans Skeptical Of Forcing Physicians To Jump Through Quality Hoops
Congress plays 'kick the can' with physicians' reimbursements. Physicians could face a 12-... Read more
HOSPITALS:
Court Order Drives 2007 Inpatient-Hospital Payment Rates
New occupational-mix adjustment doesn't yield big changes to wage index. Good news: Medica... Read more
MEDICARE ENROLLMENT:
New Medicare Enrollment Form Has Danger Zones For Providers
Doctors must read the fine print before signing the new 855I. If a physician practice's co... Read more
CPT 2007:
Inpatient Consult Codes Lose Confusing 'Initial' Label
Coumadin clinics will welcome new anticoagulant codes. You'll have two new codes to report... Read more
PART B:
Make Sure Same-Day Admit And Discharge Are Both Face-To-Face
To get it right, don't forget to note separate facility addresses. Myth: You can't bill fo... Read more
RADIOLOGISTS:
You Can Bill For CT And MR Needle-Placement Guidance
Category III codes for stereotactic therapy a thing of the past. Instead of the two curren... Read more
REIMBURSEMENT:
Daily Billing, Early Appeals Helped Cushion The Blow From Payment Freeze
Physician offices still defrosting from 9-day Medicare freeze. The worst nine days of the ... Read more
INDUSTRY NOTES ~ GAO Calls For MIP Distribution Reforms
Plus: DME manufacturers and suppliers under scrutiny for partnerships. The Centers for Med... Read more
PMDs:
CMS Clarifies PMD Coverage Determination
Implementation on codes, LCD delayed until Nov. 15.Medicare will still pay for a Group 2 p... Read more
OXYGEN:
Big Victory In Congress For Oxygen Stakeholders
Senate interest in 13-month cap proposal dwindles.Sen. Charles Grassley's (R-IA) recent pl... Read more
HOSPITALS:
Brace Yourself For A 2-Percent Payment Decrease If Your Quality Reporting Isn't Up To Par
CMS hitting hospitals in their pocketbooks for not participating in quality reporting.Many... Read more
HHAs:
Get Ready For Quick P4P Phase-In
IOM recommends measure including clinical outcomes, efficiency and patient centeredness.Th... Read more
LONG-TERM CARE:
Manage Significant Change Assessments Before They Drain Your Coffers
Follow these strategies to secure fair reimbursement for services.MDS teams that don't kno... Read more
INDUSTRY NOTES:
CMS Boosts Competition With A Call For 3 New MACs
Plus:  Physicians not using even low-cost IT tools, survey finds.The Centers for Medi... Read more
RADIATION ONCOLOGY:
Your Reimbursement For Radiation Therapy Will Be Slashed By Edits
Critical care, nursing facility care bundled with radiation treatment.Radiologists just ca... Read more
CCI EDITS:
Your Life Could Get Easier With These Deleted Edits
Deleted edits: they're not all bad news.CCI Version 12.3 doesn't just drop new edits on yo... Read more
ORTHOPEDICS:
Competitive Bidding Coming Soon--But Is The Rule Good For Your Patients?
DME bidding could have your patients limping home.The next time a patient leaves your offi... Read more
REIMBURSEMENT:
AMA Rejects Quality-Improvement, P4P Programs
Time is running out for fix to 5.1-percent cut.The American Medical Association's (AMA) $1... Read more
PRESCRIPTION DRUGS:
Your Patients Need Better Access To Drugs Under Part D, Groups Say
Patient advocacy groups also want improved drug safety through FDA.National patient-group ... Read more
NPIs:
CMS Has Removed NPI PDF From Its Web Site, But You Have Other Options
Where to look (beyond CMS' Web site) for NPI applications.Getting a National Provider Iden... Read more
HOSPITALS:
Prepare For Imminent Audits Of ED Visits
Physicians' emergency department visits could be under more security soon.A recent survey ... Read more
HIPAA COMPLIANCE:
How To Stay HIPAA compliant When Patients Can't Speak For Themselves
Incapacitated patients and HIPAA:  know you disclosure obligations.It's a common occu... Read more
CODING:
Don't Bill 75893 Or 36500 With Many Angiography Or Catheterizaton Codes
Once again, CCI makes radiology coding a minefield.October's Correct Coding Initiative (CC... Read more
INDUSTRY NOTES:
HHS To Patents--'Own Your Future'
Plus:  You've got no mail, doctors tell patients.In a partnership with six states, th... Read more
MEDICAID:
HHS Spends A Bundle On State-Based Programs For The Disabled, Chronically Ill
Industry leaders steering away from institutional programs.The federal government is spend... Read more
PHYSICIANS:
Physician Spending Grew Much Less Quickly Than Industry Leaders Expected
Fight against 5.1-percent cut begins with time already running out.There's no time to lose... Read more
HIPAA:
Stay HIPAA Compliant--Even When Every Second Counts
HHS lends a helping hand to providers dealing with emergency situations.Health care provid... Read more
REIMBURSEMENT:
Congress Considers Plan That Would Keep Payment Cuts For Some Doctors
Can a lame duck save physicians from the chopping block?Forget pay-for-performance. One ne... Read more
MEDICARE FFS:
Providers Are Happy With Their Contractors, New Survey Reveals
Rural health centers. SNFs most pleased with their FI contractors.Providers are content wi... Read more
HOSPITALS:
U.S. Hospitals Rack Up Big Bills Nationally
Find out which conditions cost payers, patients the most.In 2004, the United States' colle... Read more
ORTHOPEDICS:
Medicare Changes Multiple Procedure Indicator For Arthroscopy
Say goodbye to 50-percent pay cut for G0289.You can look forward to $48 more in reimbursem... Read more
DERMATOLOGY:
Don't Give Up On Reimbursement For G0168
Getting paid for simple repairs isn't always simple.Sometimes the carriers move in mysteri... Read more
FRAUD & ABUSE:
Suppliers Beware--The Feds Are Watching Your Medicaid Billings
Bonus:  Federal appeals court rejects 'no harm, no foul' argument regarding false Med... Read more
INDUSTRY NOTES:
PE-RVU Changes Could Cut Major Procedures By 10 Percent
Plus:  OIG uncovers $20 million in Medicare overpayments for radiology services.If th... Read more
PHYSICIANS:
PPAC To CMS--Stop The 10-Percent RVU Cut
Conversion factor still faces 5.1-percent cut.There's still time to stop a steep 10-percen... Read more
MEDICARE SECONDARY:
How To Cope With The Secondary Claims Transition
Carriers may grant extension, vendors may be able to help.If you haven't already received ... Read more
COMPLIANCE:
Patient Abandonment May Equal Fraud, OIG Warns
3 abandonment criteria can land HHAs in hot water.The HHS Office of Inspector General (OIG... Read more
CODING:
Get Up To Speed On New CCI Edits
2 CCI changes that should change the way you code.If you're not keeping up with the latest... Read more
HHAs:
Non-Compete Victory Gives HHAs A Leg Up
Top Missouri court upholds home health provider's contract.A new court decision should mak... Read more
BILLING:
Warning--Don't Use Modifier 22 Unless You Can Show Extra Work
It's not enough to document previous procedure.Heads up: A clarification of modifiers 22 a... Read more
INDUSTRY NOTES:
CMS Head Steps Down
Plus:  Stakeholders call for revisions to new price list.Say goodbye to Mark McClella... Read more
PHYSICAL THERAPISTS:
Rehab Professionals Face 10-Percent Payment Cuts
No phase-in could hit physical therapists hard.If you've worried over the Centers for Medi... Read more
HOSPITALS:
New Analysis Could Provoke CMS To Get Serious About P4P For Hospitals
New quality measures may save $1.35 billion in hospital costs.A little bit of mathematical... Read more
PRESCRIPTION DRUGS:
Senator Praises Inhalation-Drug Pricing Plan
Industry cites safety concerns.Suppliers should keep news about inhalation drugs on their ... Read more
COMPLIANCE:
You Need To Tread Carefully When Billing For Part B Drugs
Physicians can write a Part D diagnosis on prescriptions to avoid hassles.Physicians can't... Read more
PHYSICIANS:
Want To Be Free Of Consult Confusion? Here's Some Good News
It's not a consult if the requesting physician 'doesn't give a rip.'Your cries for clarifi... Read more
OASIS:
Manual Revisions--And Now Corrections To Revisions--Warrant Your Close Attention
Rapid-fire changes to manual keep agencies hopping.If you think you're up on the latest in... Read more
CODING:
Avoid Vague Phrases Like 'Patient Feeling Better' As Chief Complaint
Hail to the chief complaint--even if it's at the end of the note.Getting dinged on audits ... Read more
REIMBURSEMENT:
Is A Patient's Wound 'Not Healing?' The Right Answer Just Got Trickier
Tap new surgical wound guidance to boost revenues.An audit of how your field staff is asse... Read more
INDUSTRY NOTES:
Bush Calls For Info Gathering, Doesn't Cover Costs
Plus:  Seniors not afraid of information overload on important health issues.As promi... Read more
MEDICARE:
Mystery Solved? Your Patients With Multiple Conditions to Blame For Skyrocketing Medicare Spending
New study pegs obesity as major culprit as well.Beneficiaries with three or more condition... Read more
PREVENTIVE CARE:
Your Medicare Patients Can Get Better Preventive Care Coverage
Medicare benes not taking advantage of covered preventive services, screenings.The day bef... Read more
HHAs:
Take A Tip From The Feds Regarding HHABNs
Telemonitoring exception is one plus for agencies.The clock is ticking toward the Sept. 1 ... Read more
ASCs:
Patients Will Be Able To See Your Prices Online
More 'approved' procedures to come, along with major payment-system revamp.The Centers for... Read more
ED CODING:
Check Physician Notes Before Appealing Critical Care Claims
If you don't meet these documentation requirements, you will not win appeal.When you recei... Read more
NURSING HOMES:
Surveyors' Notes Can Help You Win An Appeal
This strategy can ante up the 'rest of the story.'The CMS 2567 can say one thing, but if s... Read more
REIMBURSEMENT:
CMS Steps In to Mitigate Effect Of RAP Delay
Error can't be fixed this late in the game, feds say.Home health agencies (HHAs) in 16 sta... Read more
INDUSTRY NOTES:
Shocking--QIOs Have Positive Impact On Providers, New Study Finds
Plus:  Feds invest in building NHIN Infrastructure.After enduring serious scrutiny fr... Read more
COMPLIANCE:
End Of Moratorium Doesn't Mean A Cease-Fire In War On Doc-Owned Hospitals
Scrutiny from the feds won't end with moratorium.You may have rejoiced when a Medicare mor... Read more
REIMBURSEMENT:
9-Day Cash-Flow Dead Zone Could Be Longer For Many
Prepare now for slow end of September--delay may turn into 12 days.You're already bracing ... Read more
BILLING:
What To Do When Your Carrier Isn't Reimbursing Your Claims
More tips on handling the 9-day payment freeze.Your cash flow will be hit hard in late Sep... Read more
HEALTH PLANS:
Insurers Scramble To Gain Part D Market Share
Last year's winners plan to cash in with expanded PFFS and MA plans.Late last month, for t... Read more
PHYSICIAN PRACTICES:
CMS May Have Evicted You From 'Condo' Laboratories
Now's the time to look into your 'pod labs' arrangements.In recent years, many urology and... Read more
STRATEGY:
Don't Let Manufacturers Snow You Into Investing In New Gadgets
Beware of buying equipment before you're sure of reimbursement.You've heard other offices ... Read more
HIPAA:
BCBSA's New Database Product Has Privacy Advocates Crying Foul
It could promote quality care nationally, but it could also violate HIPAA.The Blue Cross a... Read more
INDUSTRY NOTES:
Nursing Home Payments Set To Increase In 2007
Plus:  Medically unlikely edits are back.The annual update notice of new payment rate... Read more
REGULATIONS:
2007 Brings A Plethora Of Changes--Are You Ready?
Here's your checklist of what the future really holds.With so many changes being talked ab... Read more
FEE SCHEDULE:
You Can Bill For Casting Supplies, Nutrition Therapy Next Year
More change in the 2007 Physician fee schedule.Physicians' reimbursement for casting and s... Read more
REIMBURSEMENT:
Look Ahead To Proposed Payment Changes--You Could Change The Future
Don't wait until these proposals become final to make your voice heard.Now's the time to s... Read more
QUALITY OF CARE:
Gear Up To Provide Quality Measurements To Government
President plans technology standards for health care providers.Your quality and outcomes c... Read more
MEDICARE NEWS:
Medicare Growth Shrinks--But More Cuts On The Way
Bonus:  Legislators want to model universal health coverage after Medicare.The growth... Read more
HOSPITALS:
Respond To Surveys--Or Face $10,000 Per Day In Fines
Doctor-owned hospitals risk having to cough up $12 million in penalties.Medicare finally e... Read more
COMPLIANCE:
You Could Soon Get Help Upgrading Your Computer Systems
CMS, OIG loosen up on donations of e-prescription, EHR systems.Hospitals will be able to d... Read more
PHYSICIANS:
Brace Yourself For 5.1-Percent Cut Next January
Multiple imaging scan discount won't rise next year after all.It's worse than you've feare... Read more
INDUSTRY NOTES:
Your Computers May Be Able To Talk To Each Other
House and Senate set to hash out fate of health IT.Stay tuned: You could be facing a tight... Read more
PART D:
Bulk Of Part D Complaints Are About Enrollment, Disenrollment
More complaints about stand-alone PDPs than MA PDPs.New statistics from the Centers for Me... Read more
APPEALS:
Learn How To Fight Billing Revocations All The Way To Court
You can appeal enrollment denials to an ALJ.Be prepared for some changes to the appeals sy... Read more
MEDICARE:
CMS Experiments With Transferring Claims Data To PHRs
My.Medicare.gov pages not 'true' PHRs, agency says.The Centers for Medicare & Medicaid... Read more
PHARMACEUTICALS:
Part D Paying Off For Big Pharma
Drug companies are cashing in, especially on Medicaid benes who now have Medicare drug cov... Read more
DME SUPPLIERS:
Feds Clarify Your Recourse In SNF Billing Snafus
Don't let nursing home consolidated billing drain you.Your staff know which HCPCS codes ar... Read more
REIMBURSEMENT:
2-Year Delay Possible For Steep Imaging Cuts
New bill offers solid alternatives to payment cuts.Imaging scans such as CT angiography to... Read more
PHYSICIANS:
What You Can Do To Urge 2007 Pay Hike
Your payments have been frozen since 2001, senators note.If Congress doesn't get its act t... Read more
MEDICAID:
Medicaid Is Getting An Expensive Makeover
Two major initiatives give states a huge cash injection from the federal government.Policy... Read more
INDUSTRY NOTES:
Get Ready For More Quality Scrutiny
Plus: CMS thinks e-prescribing is the answer to a dangerous problem.Two major quality... Read more
HOSPITALS:
Senators, Representatives Battle CMS To Protect Your IPPS Payments
Lawmakers try to stall Medicare payment changes to avoid a hasty implementationIf you're w... Read more
REIMBURSEMENT:
Here's The Scoop On What You Might See Under A Revamped IPPS
CMS tries to set the record straight regarding its proposed rule.Your hospital payments co... Read more
MEDICARE:
Look For More Payment System Shake-Ups And P4P Adoption
New expenditure data could spark further payment reforms.Although revised Part D spending ... Read more
PART D:
Industry Leaders Want Benefit-Structure Changes To Part D
It's official--Part D desperately needs changes.Despite recent statistics showing that man... Read more
HIPAA COMPLIANCE:
Nix Security Problems With Walkthrough Inspections
Follow this advice to keep your compliance plan in shape.Your security compliance program ... Read more
FRAUD & ABUSE:
Get Ready--Feds Will Use Medicare Fraud-Fighting Tactics For Medicaid
Contractor audits, payment scrutiny ensues.At least 100 full-time Centers for Medicare &am... Read more
INDUSTRY NOTES:
Medicare Turns Your Imaging Services Reimbursement Upside-Down
Plus:  New law could leave millions of eligible Medicaid enrollees without health car... Read more
COVERAGE:
CMS Wants More Evidence To Fast-Track Coverage Determinations
Get ready for extensive documentation demands.After the Centers for Medicare & Medicai... Read more
SUPPLIERS:
Prepare Yourself For Looming DME Quality Standards
Final version of standards due this month.Expect a quality-standards wake up call this mon... Read more
PHYSICIANS:
You May Not Have To Cope With DME Competitive Bidding
MedPAC tries to prevent competitive acquisition from becoming unreasonably restrictive.The... Read more
COMPETITIVE BIDDING:
Bidding Tailored Toward Conventional Suppliers
Therapists, docs lobby for exclusions.Small suppliers of durable medical equipment, prosth... Read more
ONCOLOGISTS:
You Have Representatives On Your Side In Cancer-Care Crisis
CMS called on the carpet for IVIG, oncology access problems.Oncologists, the House Ways &a... Read more
HEALTH PLANS:
How Medicare's New CDHP Frenzy Will Change The Marketplace
In addition to the new MSAs, Medicare benes can now have access to other HSA-like plans.Me... Read more
REIMBURSEMENT:
HHAs--Get Ready Now To Avoid Payment Hold Problems This Fall
Try these 5 tips to avert a cash-flow crunch during the mandated hold.Now's the time to cr... Read more
INDUSTRY NOTES:
LTC Facilities May Need NPIs For Recertification Soon
Plus:  Noridian gears up as new DME MAC in Jurisdiction D.Long-term care providers' c... Read more
Reimbursement:
Physicians Need to Brace ThemselvesFor These Work-RVU Hits
Skin debridement, hip arthroplasty may be money losers next year Get ready: Work relative ... Read more
Regulations:
HHAs Have New Doc Orders Option Under Revised ABN
Providers will use new option the most, CMS says. The new home health advance beneficiary ... Read more
Oncologists:
Prevent Steep Cuts To Oncology Drugs: Make Your Voice Heard
Oncology drugs overpriced by as much as 185 percent Five commonly billed oncology drugs ar... Read more
Physicians:
Not All Good News For RVU-E/M Boost
Higher-level E/M codes are biggest winners Not all evaluation & management (E/M) codes... Read more
Oxygen:
New Report May Be The Ticket To Staving Off Medicare Cuts For Home O2 Therapy
Cost data could drive change A new report on home oxygen therapy costs could help oxygen s... Read more
Billing:
Don't Write Off Low-Income Copays Until You Get The Facts
 Good news: Your state may cover DME copays, even for non-Medicaid patients If you se... Read more
Cardiologists:
You May Have To Close Your In-Office Cath Labs Or Scanning Centers
RVU changes could mean $200,000 pay cut per cardiologist Cardiologists face just a 4-perce... Read more
Industry Notes:
You Could Have An Easier Time Billing For Off-Label Cancer Drug Uses Soon
Beware denials that result in LUPAs Congress should expand national coverage for off-label... Read more
Regulations:
CMS Backs Down On Transmission Of OASIS For RAP Billing
HHAs breathe sigh of relief over last-minute pull-back If you don't want to transmit OASIS... Read more
Oasis:
Don't Forget These OASIS Changes
What you need to know about the new regulation The OASIS regulation that took effect June ... Read more
Physicians:
Work RVUs For Level-3 Office Visits Set For 37-Percent Hike
Everything changes starting next January. Will you be ready? Good news: Your payments ... Read more
Pay-For-Performance:
MedPAC Pushes Process Measures For HHA Quality
Home health is ready for P4P, report to Congress says Patient outcomes won't be the only t... Read more
HHAs:
9 Measures You're Likely To See Used For P4P
Get to know these crucial consensus measures. It's only a matter of time before Medic... Read more
Reimbursement:
Suppliers In Holding Pattern Over Nebulizer LCD
Draft policy could reduce payment for one drug by 95 percent Whopping Medicare payment cut... Read more
Enforcement:
Report And Request Aren't Enough For Consults Without Medical Necessity
Use of modifier 25 exposes that doctor knew he flouted the rules.If you're worried about r... Read more
Coding:
Prepare For Imminent Audits Of Your ED Visits
Double-check: Does your E/M documentation support levels? Your emergency department (... Read more
Industry Notes:
MACs Replace DMERCs Next Month
Plus: One code will increase 12 percent next year.In 18 states and the District of Columbi... Read more
HHAs:
'Substantial Compliance' Not Enough In Deferred Comp Reimbursement Case
Medicare manual rules, court says.If you want to fight the rules in the Medicare Provider ... Read more
REGULATIONS:
July 1 ABN Deadline Would Set Agencies Scrambling
Keep a look out for last-minute change.Home health agencies (HHAs) should prepare for the ... Read more
BILLING:
Same Group, Different Specialty--How To Collect What You Deserve
Stand your ground when your carrier shoots you down on new patient visits.Watch out: It's ... Read more
CODING:
Missing Details Keep Mobility Device Suppliers Guessing
Fall implementation looms for new codes.Changes in the way Medicare classifies and pays fo... Read more
HOSPICE CARE:
Master 4 Modifiers To Ensure Payment For Hospice Care
Go to the hospice for payment as a last resort.Billing for hospice patients can seem frust... Read more
RADIOLOGY:
Why You May Get Paid For More Chest Radiograph CADs
You could have more chances to bill 0152T soon.You may be able to bill for chest radiograp... Read more
HOSPITALS:
Huge Increase In High-Level ED Visits Brings On Hospital Billing Scrutiney
Ed visits may see upcoding emergency soon.Emergency Department physicians and hospitals ma... Read more
INDUSTRY NOTES:
Don't Expect Any Action On Medicare Cuts Until Year's End
Plus:  Abbreciations may shorten your patients' lives.A desire to prevent a cut to yo... Read more
MEDICARE:
CMS Has A Lot Of Work To Do To Whip Medicare Into Shape
Medicare can't keep up with rapid technological advances, MedPAC says.Providers must becom... Read more
HHAs:
New ABNs Must Go By New, Expanded Rules
Agencies hope for more clarity in ABN instructions.It's official: You have at least three ... Read more
ENFORCEMENT:
Feds Base False Claims Charges On Erroneous Cost Report
And an act of Congress couldn't hurt.A lawsuit to challenge a cost report disallowance bac... Read more
SUPPLIERS:
Efficiency Key To Post-Cap Survival For Oxygen Providers
And an act of Congress couldn't hurt.More questions than answers remain regarding how the ... Read more
CODING:
New Edit Could Cost You $1,500 Per Surgery
Spine surgeons stiffen their backbones in opposition to bundle. Watch out: A new Corr... Read more
BENCHMARKS:
Use Visit Benchmarking To Boost Financials, Outcomes
5 tips keep you in the black and off the feds' radar screen.It's time to put on your detec... Read more
INDUSTRY NOTES:
1 In 5 Doctors Now Has Access To Full-Fledged Information Technology
Plus:  Hospitals get new quality measures to live up to.Nearly 21 percent of doctors ... Read more
REIMBURSEMENT:
New Rule Could Boost RVUs For E/M Codes At Surgical Procedures' Expense
Include the 'KX' modifier on every line of your PT claims.You could get a glimpse of the f... Read more
CMS:
PPAC Meeting Yields No Sympathy For Your Part D Pain
Nurse practitioners soon may be able to bill for their own services in hospitals.The Cente... Read more
SUPPLIERS:
Get Answers Now To Contend With Bidding Challenge
Suppliers play catch-up as deadline for comments approaches.If you're looking for answers ... Read more
PATIENT NOTICES:
HHAs Don't Need To Worry About ABN Due Date Until September
'Dual use' period in effect, official tells forum listeners.Home health agencies (HHAs) ha... Read more
GASTROENTEROLOGISTS:
Your Carrier Will Have Clearer Answers For Coding Certain Screenings Than CMS
CMS officials start backtracking on February clarification.If you thought your doubt and c... Read more
KICKBACKS:
Kickback Case Could Be Tip Of The Iceberg
HHA owner sentenced to years in jail for fraud plea.Home health agencies (HHAs) could be i... Read more
FRAUD & ABUSE:
Prosecutors Find Nursing-Home Swallow Tests Hard To Digest
Radiologist faces a 13-count indictment for Medicare fraud.Radiologist Robert Riether and ... Read more
COMPLIANCE:
Get A Clear Understanding Of Complicated Alternative-Signature Rules
Research your state's laws before you look into stamps or e-signatures.Your doctor's getti... Read more
AUDITS:
Keep An Eye On The Charts Requested by 'Bounty Hunters'
If the RACs recycle your appealed claims, contact CMS.The Recovery Audit Contractors (RACs... Read more
NPIs:
Deadline To Obtain NPIs For New Doctors Is Coming Up
Warning:  Carriers won't give you any leeway on enrollment jam.If you don't have nati... Read more
REGULATIONS:
How ABN Spec Savvy Can Stave Off Non-Compliance
Check out these must-know vitals on cost estimates and pre-printed information.If home hea... Read more
HOME HEALTH:
Zero In On Anti-Kickback, False Claims Compliance--Or Risk All
Suppliers pay millions in two recent cases.Batten down the compliance hatches or your home... Read more
COMPLIANCE:
Prepare Now For Modifier 25 Crackdown
Make sure your documentation is in order before billing separate E/M service. If you ... Read more
CODING:
Believe It Or Not, You May Be Able To Bill For Unlikely Services
Watch out for MUE proposed in August.Good news: You may not have another smothering layer ... Read more
CMS:
Speak Up To Keep Bad Local Policies From Spreading
Stop using the obsolete QV modifier for PET scans.If you like your carrier's Local Coverag... Read more
INDUSTRY NOTES:
Final Rule Won't Disrupt Organ Procurement Services
OPOs face new quality measures, competitive certification.A new final rule will change the... Read more
CERTIFICATION:
New Medicare Certification Rule Weeds Out Past Variances
Prompt payment is one goal, feds say.A rose is a rose--and now Medicare certification is M... Read more
PART D:
Part D Policy Shift Brings New Drugs On Board
Plans can cover prescription niacin, feds allow.Medicare beneficiaries with high cholester... Read more
PHYSICAL THERAPY:
PT Claims Not OK, Warns OIG
Medicare spends $136 million on improper claims.Providers' physical therapy claims could b... Read more
CONSULTS:
CMS' New Consult Guidelines Still Confuse Providers
Providers need to make sure they have the written request in their files.Most consults are... Read more
CONSOLIDATED BILLING:
SNFs Come Up Short On Consolidated Billing Arrangements
SNFs still stuggle with unexpected 'under arrangement' bills from suppliers, agency says.S... Read more
HEALTH PLANS:
Partnerships And Premiums Propel Leading Part D Plans
Standouts dominate individual PDP and MA-PDP markets.Only two insurers have managed to cap... Read more
COVERAGE:
Are You Ready For The Bariatric Surgery Coverage Checklist?
Only certified facilities will meet coverage criteria.Your surgeon can obtain Medicare rei... Read more
INDUSTRY NOTES:
The End Of September Could Be Your Cash Flow Downfall
Medicare will freeze your payments.Brace yourself for nine lean days in late September.The... Read more
OUTPATIENT THERAPY:
Use The Right Form For Therapy Cap Communications
Confusion reigns when it come to ABNs.If the ABN and its cousin the NEMB are throwing you ... Read more
PHYSICIANS:
Consult Confusion Just Got More Tangled
You don't have to verify documentation, but it should be there.You've been tearing out you... Read more
CODING:
Reap The Rewards For VAC Wound Care Now
Physicians can bill for 97605-97606.Cutting-edge wound care technology will now receive th... Read more
COPAYMENTS:
Don't Write Off Low-Income Copays Until You Get The Facts
Good news:  Your state may cover copays, even for non-Medicaid patients.If your pract... Read more
PRESCRIPTION DRUGS:
OIG To CMS--51 Drugs May Be Overpriced
CMS disputes OIGs calculations, however.A few dozen Part B drugs could be facing steep dro... Read more
INCIDENT-TO-BILLING:
Pre-2002 Incident-To Claims Could Still Wind Up In Court
Now is the time to scrutinize your documentation.Ignorance of the incident-to law is no ex... Read more
HHAs:
CMS Piles On ABN Burdens In New Q & A
You still have to issue an ABN if the reduction is included in the recent plan of care.Get... Read more
DME SUPPLIERS:
Strategic Planning Tips Help DME Players Stay In The Game
Clues in proposed bidding rule can help you prepare.The feds continue to wrestle with the ... Read more
INDUSTRY NOTES:
CMS May Be Just Going Through The CAP Motions
Plus:  Medicare defrauder loses medical license, title.The Centers for Medicare &... Read more
SUPPLIERS:
Bidding Rule Prompts Trade Groups' Call To Action
Bidding, new quality standards confront DMEPOS suppliers.Suppliers of durable medical equi... Read more
PRESCRIPTION DRUGS:
No Backup Source For Providers Who Rely On CAP Vendor For Drugs
This CAP has only one featherThe Competitive Acquisition Program (CAP) for Part B drugs lo... Read more
HOSPICES:
Continuous Care Probe Hits Hospices
Rise in utilization sparks scrutiny.Increased utilization of costly continuous home care i... Read more
HIPAA:
Redouble Privacy Rule Efforts--Or Risk Fines, Lawsuits
Health systems struggle to comply, survey suggests.Many health care providers' policies re... Read more
MEDICAL REVIEW:
Combat Continuous Care Scrutiny With 6 Steps
Watch for red flags that could suggest over-utilization.Hospices that want to weather the ... Read more
HHAs:
Soaring Gas Prices Squeeze HHA, Employee Budgets
Agencies risk losing staff to eroding compensation, hope for IRS to step in.The return of ... Read more
IMAGING:
Imaging Reimbursement Could Be In For A Third Hit Soon
Neighboring physicians see 10 percent difference.Physicians' practice expenses for MRIs an... Read more
INDUSTRY NOTES:
Providers Say Good-Bye To Part B Carriers And Hello To MAC Transition
Plus:  Medicare will cover pancreas transplants--but only in a few cases.Part B carri... Read more
AUDITS:
Get To The Bottom Of Audits--And Come Out On Top
3 red flags could make providers' claims suspicious.Why do bad audits happen to good physi... Read more
CONTRACTORS:
DMAC Transition Delayed Until Fail In 2 Regions
Bidding, wheelchair final rule, UPIN information also revealed in forum.Suppliers in Medic... Read more
DENTAL SERVICES:
2 Practices Succeed In Overturning 'Routine' Dental Denials
Medicare will cover dental services when they're medically related.Providers aren't taking... Read more
CMS:
Nebulizer Payment Revisions Demand Proof Of Medical Necessity
Providers:  Don't miss the draft LCD--and a chance to comment.Providers who bill Medi... Read more
BILLING:
New Torsion, Mental Status Codes May Help Providers Reap Reimbursement
Billers need to start mastering the new ICD-9 codes now.With new ICD-9 codes on the horizo... Read more
COMPLIANCE:
Come Clean, Or We'll Fight Dirty, OIG Warns
Doctors' deals with hospitals could be under the lens soon.The HHS Office of Inspector Gen... Read more
INDUSTRY NOTES:
Congress Still Struggles To Put DRA To Bed
Plus: HSAs, HDHPs may top new plan growth this year, survey predicts.Congressional re... Read more
PVRP:
Physicians Can Give P4P A Test Run--With No Pay At Stake
Physicians who start now can receive a confidential report by December.Medicare's Physicia... Read more
P4P:
How HHAs Are Preparing For P4P
Payment mechanism could take HHAs by surprise.Pay-for-performance could determine home hea... Read more
REIMBURSEMENT:
Get Ready--CMS Could Slash Physician Payments To The Bone Next Year
A 4.6-percent cut awaits providers in 2007, CMS estimates.The Centers For Medicare & M... Read more
PART D:
5 Ways Part D Plans Are Positioning For New Business
New studies reveal what worked for PDP frontrunners in 2006.Whether they offer a standalon... Read more
CODING:
A Closer Look--How To Properly Document Wheelchair Medical Necessity
Hint:  G0372 must be on the same claim as E/M code.Providers: Don't miss out on an ex... Read more
INDUSTRY NOTES:
PMD Suppliers Say 'Proceed With Caution' Under Final Rule
Plus:  MA Plans could earn a pay raise.Federal regulators have spoken, but suppliers ... Read more
PHYSICIANS:
Providers Need To Avoid Getting Lost In The NPI Transfer Shuffle
Bonus:  Physician can't be sued for emergency care to other doctors' patients.When ph... Read more
HEALTH PLANS:
Streamline Part D Turnaround Time To Head Off Potential Regulatory Changes
Most EHR systems fall to track revisions' sources, study shows.Lagging Medicare Part D dru... Read more
PART D:
CMS Mulling Pharmacist Payment Adjustments To Shore Up Drug Benefit
Industry consolidation may narrow Medicare drug benefit to fewer plans next year.News repo... Read more
P4P:
Home Care Not An Exception For P4P Shift
CMS plans to launch a P4P demo for the home care industry--soon.Providers can't just ignor... Read more
CONSULTATIONS:
OIG Initiates A New Crackdown On Consult Billing
Three out of four consults billed incorrectly, OIG says.Consults look like a juicy target ... Read more
COMPETITIVE BIDDING:
Bidding Rule Coming Out 'Very Soon,' CMS Promises
Bid items may vary for different bid areas.Durable medical equipment suppliers soon will s... Read more
THERAPY:
HHAs Should Hold Off On Expedited Determination Notices For Part B Therapy
They can't reach for HHABNs either.Home health providers can avoid unnecessary extra work ... Read more
NURSING HOMES:
RUG Software Could Be Costing LTC Facilities Thousands
Software snags may drag down nursing homes' per diems.Without naming names, the Centers fo... Read more
BUDGET:
Senate, House Budget Committees Pass Budget Resolutions
Republican struggle could mean bad news for Medicare.On March 16, the Senate passed the bu... Read more
INDUSTRY NOTES:
Feds May Look Into Podiatrists' Nail Debridement, Chiropractors' Services
Plus:  OIG offers opinion on physician's office housing a DME supplier.Medicare could... Read more
EHRs:
Lacking Audit Trails Could Render EHRs Moot In Court
Most EHR systems fail to track revisions' sources, study shows. Electronic health records ... Read more
Medicare:
Hospices May Get Higher Payments At Beginning, End Of Stays
MedPAC looks to shake up hospice pay--but don't count on a case mix adjuster.After more th... Read more
Hospices:
Fast Facts -- Medicare Hospice Payments
Non-cancer diagnoses growing for hospice patients, along with lengths of stay.Providers sh... Read more
Suppliers:
4-Step Program Positions Suppliers For DRA Fallout
Suppliers should get proactive about budget changes, experts adviseSuppliers shouldn't let... Read more
Budget:
Senate Proposes To Preserve Home Care Spending
But physician fix threatens home care reimbursement anyway.After a double whammy from Pres... Read more
Billing:
CMS Transmittal Clarifies Proper E/M Claims Filing
Warning: Providers may be making crucial mistakes in E/M billing.A recent transmittal from... Read more
Nursing Homes:
'Shelter In Place' Emergency Management Plans May Be Insufficient
Upcoming GAO report could make a push for emergency SNF evacuations.Skilled nursing facili... Read more
CMS:
'Medically Unbelievable' Edits Go Beyond CMS Mission
PPAC wants CMS to withdraw MUEs. The Centers for Medicare & Medicaid Services see... Read more
Physicians:
Medicare Needs More Up-To-Date Data On Practice Expenses
MedPAC also wants to coordinate care for patients with chronic conditions.The Centers for ... Read more
SPENDING:
Hospitals Must Bare It All Under New Price Transparency Initiatives
Consumer-driven health care drives more purchasing power into benes' hands.Hospitals' pric... Read more
REIMBURSEMENT:
Class III DME Could Lose Out On Payment Update
Rapid spending growth, pre-marketing costs for high-risk devices concern GAO.Class III dur... Read more
AUDITS:
Medicare 'Bounty Hunters' To Receive Payment For Reconnaissance
P4P train 'has left the station,' CMS says.Providers who thought they were safe from the R... Read more
BUDGET:
HHAs Bristle At 2007 Rate Freeze Proposal
MedPac pushes freeze at House hearing.The final decision on 2007 Medicare payment rates is... Read more
HHAs:
PPS Inaccuracy Should Preclude Freeze
Underpaid services could take a painful and inappropriate hit.One big reason not to pass a... Read more
PRESCRIPTION DRUGS:
Medicare Overpaid $110 Million For Part B Drugs
IOG report could trigger a future slash in drug payments.This may be hard to believe, but ... Read more
ONCOLOGY:
CMS Reverses Course On Oncology Demonstration
Gyn-Oncs win opportunity to resubmit denied demonstration claims.Reversal of a Centers for... Read more
INDUSTRY NOTES:
Court Rules In Favor Of ER 'Balance Billing'
Plus: Watch out for state, federal laws on charging patients interest and surcharges.... Read more
Part D:
15 States Take Part D 'Clawbacks' To The Supreme Court
Payments for dual eligibles' drug coverage are an 'unconstitutional tax,' states allege. S... Read more
Compliance:
4 Tricky Stark Law Exceptions Just Got Simpler
Flat fees, fair-market payments won't land providers in hot water.Nobody ever accused the ... Read more
P4P:
AMA Defends Quality Improvement Deal With Congress
Association didn't give away the store on P4P, it insists.Specialty associations reacted w... Read more
Regulations:
DME MAC Transition Delay May Leave Suppliers Bewildered
Are DMERCs ready for the end of power mobility CMNs? Why some think they're not.Two durabl... Read more
Reimbursement:
Brace For More Changes In Capped Rental Regs
Still no details on oxygen maintenance and service payments.New rules for home medical equ... Read more
Billing:
10 Diagnoses Could Obtain New ICD-9 Codes This Year
Secondary diabetes tops the list of coding improvements.The next batch of ICD-9 diagnosis ... Read more
Payments:
No Rural Add-Ons For Many HHAs
CMS promises fix soon.Thanks to a technical glitch, many home health agencies will have to... Read more
Billing:
3 Keys To Securing Rightful Home Health Payments
Changing codes could cause reimbursement snags.Many home health care providers are confuse... Read more
Case Study:
'Teamwork' Helps Providers Manage Therapy Under New RUG System
Following one facility's lead could help boost outcomes and payments.Providers may see the... Read more
REIMBURSEMENT:
MedPAC Report Pins Payment System Flaws On 'Overvalued' Services
Congress must put the brakes on health care spending, and Medicare should lead the way.Pay... Read more
PATIENT RIGHTS:
HHAs Brace For An ABN Avalanche
Reasons to give notices just multiplied.Home health agencies will be taking on an even hea... Read more
REGULATIONS:
Fast Facts--Home Health ABNs
Insufficient notices can land providers in hot water.Providers who don't understand the in... Read more
BILLING:
New CMNs, DIFs Raise Questions Of Medical Necessity
Physician education is the key to good documentation.Documentation of medical necessity re... Read more
PART D:
Pharmas Work To Cover 'Doughnut Hole' For Low-Income Benes
Coalition lacks major players--kickback issues could arise.In an attempt to forestall pote... Read more
EMERGENCY MEDICINE:
Billing New Moderate Sedation Codes Now Could Pay Off Later
Medicare is keeping watch over providers' code usage.Medicare never paid for conscious sed... Read more
INDUSTRY NOTES:
Demonstration Project Offers New Outlook For Disease Management
Plus:  Home health spending increase spell more bad news for HHAs.The Centers for Med... Read more
FRAUD & ABUSE:
Hospice Chains Shell Out $13 Million Each In Settlements
Lawsuit, DOJ take bites out of VITAS and Odyssey earnings.The backlash against the booming... Read more
COVERAGE:
The Future Looks Bright For 'Mini-Medical' Plans
Escalating health care costs push employers to consider bare-bones options.Consumer-direct... Read more
MEDICARE:
Privatization--Medicare's Next Evolutionary Step?
Managed care may have another chance at success.Part D may have turned traditional Medicar... Read more
COVERAGE:
Outpatient Therapy Caps' Short-Term Relief May Not Resolve Larger Issue
CMS rolls out two-pronged exceptions process.Financial limitations on outpatient therapy s... Read more
REIMBURSEMENT:
Providers Bear The Burden Of Proof For Outpatient Therapy Exceptions
A new modifier provides the key that unlocks automatic exceptions.There are nearly 100 dia... Read more
HIPAA:
Final Enforcement Rule Nails Violators With Costly Penalties
Privacy, security and EHR compliance are still problems, survey reveals.A final rule, plus... Read more
HSAs:
HSAs May Foul Up Comprehensive Plans' Risk Pools
CMS expands coverage, but restricts it to certain facilities.The White House has been exto... Read more
INDUSTRY NOTES:
Experienced Surgeons Make The Difference For Bariatric Surgery Coverage
Plus:  Why medical care visits in the United States have skyrocketed.Medicare will no... Read more
REIMBURSEMENT:
Top 10 Payment Changes In The New Deficit Reduction Act
Medicare providers get to start the 2006 claims year all over again.The intense Congressio... Read more
HHAs:
Home Health PPS Reins In Medicare Spending--To A Potential Fault
Financial incentives could lead providers to compromise quality of care.Steady hospital re... Read more
PHYSICIANS:
CMS Postpones Payments For PMDs
Congress withholds funding to delay interim final rule's implementation.Power wheelchairs ... Read more
HIPAA:
Medicare Cracks Down On Secondary Payer Billing And Reimbursement
How to get reimbursement for a paper claim that a contractor has denied.Physicians, suppli... Read more
APPEALS:
Here's Who To Call To Get Appeals Settled Faster
Some carriers require redeterminations even for minor errors.The new and improved appeals ... Read more
ONCOLOGY:
Agencies Combine Forces To Combat Cancer
A new HHS alliance puts biomarkers to the test.A first-time collaboration between differen... Read more
COVERAGE:
Plans Struggle To Justify Premium Costs To Even The Deepest Pockets
Employers' best efforts aren't enough to make health care affordable for non-retiree worke... Read more
Part D:
HHS Acknowledges Problems, Lays Out Action Plan In Part D Progress Report
'We make no excuses,' says HHS. The ashes are still falling in the aftermath of Medicare's... Read more
Medicare:
CMS Shells Out Millions In Improper Ambulance Transport Payments
Medicare needs to better scrutinize dialysis and nonemergency transport claims.The HHS Off... Read more
Payments:
Drug Plan May Ring In Below Cost Estimates
Early projections hint at plan's success but rankle skeptics.Good news about the Medicare ... Read more
Budget:
President Cuts Billions From Short-Term Medicare, Medicaid Funding
Budget reconciliation bill becomes law, sets the tone for further budgetary growth restric... Read more
Reimbursement:
Medicare Reclassifies Timed-Backup Respiratory Assist Devices For Rental Caps
Faulty information from DME regional carriers led to overpayments, CMS allegesBeginning Ap... Read more
Fraud & Abuse:
Improper Medicare Payment Reductions Help Surpass Bottom-Line Goal
Incentive-based contracting reform may help to eliminate coding errors and incorrect payme... Read more
Coverage:
CDHPs Lead Cost-Conscious Consumers To Skimp On Preventive Care
High-deductible plans have reduced medical costs but may encourage penny-pinching to a fau... Read more
Pharmacists:
Rx Hotline Could Meet More Rigorous Standards In 2007
Part D plans need separate lines for providers and benes.Pharmacists and providers can exp... Read more
PART D:
Plan Formularies Fail To Provide Dual Eligibles With Access To Critical Meds
Enrollees must jump through contingency hoops to obtain non-formulary drugs.Prescription d... Read more
NURSING HOMES:
Nursing Homes Receive Poor Marks For Quality And Safety
Weak oversight, recurring understatements and poor compliance continue to plague nursing h... Read more
REIMBURSEMENT:
Medicare Expands Coverage For NPP Visits
SNF's and standard NFs have new reimbursement and billing options.Qualified non-physician ... Read more
HOSPITALS:
Specialty Hospitals Move In On Community Hospitals' Ability To Prosper, Study Says
Hospitals raise their defenses, fearing that specialty outfits may soon take over the neig... Read more
SPECIAL REPORT:
President Bush Backs Controversial Health Care Initiatives For 2006
HSAs, medical liability reform get strong White House support.In spite of ongoing glitches... Read more
PHYSICIANS:
New Lens Technology Means A $50 Payment Increase For The Next 5 Years
CMS expands coverage for new IOL models.A new-technology intraocular lens compensates for ... Read more
LTC HOSPITALS:
PPS Changes Will Bring LTC Hospital Payments In Line, CMS Hopes
Inflation adjustment calculations for LTC hospitals may soon change.The Centers for Medica... Read more
DUAL ELIGIBLES:
Health Plans, CMS Agree To Reimburse States; Stopgap Drug Coverage for Dual Eligibles
Senate keeps reimbursement legislation on 'simmer.'At least 26 states have stepped up to t... Read more
REIMBURSEMENT:
Private Sector's Administrative Costs Rival Medicare
Medicare cost reports don't tell the whole story, study reveals.Health care policy analyst... Read more
HEALTH:
E-Prescribing goes Under The Microscope
CMS spends millions of dollars on 'testing teams.'A new pilot program will evaluate e-pres... Read more
PHYSICIANS:
Prescription Drug Package Inserts Get A User-Friendly Makeover
Long-overdue redesign improves information but sparks controversy.Physicians may soon find... Read more
PART D:
Poll Measures Significant Rx Coverage Denials
Confusion is no longer the biggest problem with Part D.Millions of seniors who are still s... Read more
MEDICARE:
Baby Boomers Buckle Under Crippling Health Care Costs
Without help, older adults may face further financial hardship after retirement.Industry e... Read more
COVERAGE:
Private Plans To Blame for Part D's High Costs
A 'centrally administered' Medicare drug program could be more cost-efficient.Enlisting pr... Read more
PART D:
Enrollment Nightmare Forces States To Enact Emergency Drug Coverage
Rocky Part D rollout leaves many without prescription drug accessWhile system glitches lea... Read more
PHYSICIANS:
Payment Fluctuations Don't Stop Physicians From Accepting Medicare Patients
Medicare acceptance relies on more than physician reimbursement, study suggestsPhysician a... Read more
REIMBURSEMENT:
IPF Payment Changes Could Buy Better Psychiatric Care
Freestanding governmental psychiatric hospitals may get the largest pay increaseInpatient ... Read more
LTC:
Baby Boomers Could Be The Straw That Breaks LTC's Back
Leaders speak out with aggressive propositions on LTC reformReady or not, over the next 10... Read more
MEDICAID:
Money-Saving Medicaid Waivers Sacrifice Quality-Of-Care
Flexible LTC options could end up costing benes access to Medicaid coverageMillions of agi... Read more
INDUSTRY NOTES:
Generic Statins Could Clinch Significant Part D Savings
Plus:  MedPAC's hospital PPS update recommendations receive backlash from AHALow-cost... Read more
PHYSICIANS:
PVRP Revisions Help Physicians 'Test the Waters'
CMS tries to assuage docs before tying quality reporting to Medicare payments.Quality impr... Read more
PVRP:
Core Starter Set Measures
• Aspirin at arrival for acute myocardial infarction• Beta blocker at time o... Read more
OUTPATIENT THERAPY:
Vague Claims Data Poses Challenge To Therapy Trends And Coverage Assumptions
Therapy cap controversy renews focus on coverage and spending growthNotable growth in outp... Read more
OUTPATIENT THERAPY:
Therapy Caps Tied To Spending, Payment Update
Therapy caps reduce provider spending but threaten to escalate benes' out-of-pocket burden... Read more
SPENDING:
Health Care Spending Shows Signs Of Slowing
Reduced growth stirs up mixed emotions among industry leaders The 7.9 percent rise in... Read more
SPENDING:
Medicaid, Managed Care Restrictions Put The Brakes On Spending Growth
Reduced Rx spending wasn't the only factor playing 2004's declining health care spending g... Read more
INDUSTRY NOTES:
CMS Confirms Retroactive Physician Payment Adjustments
Plus:  Bipartisan bill could extend Part D enrollment deadlineProviders who've been c... Read more
COVERAGE:
Part D Contingency Plans For Dual Eligibles Still Riddled With Pitfalls
GAO report questions protections for benes--much to CMS' displeasure.A safety net is in pl... Read more
PART D:
States Chime In With Dual Eligible Transition Concerns
Focus group fears increased cost obligations and inadequate support.The Centers for Medica... Read more
PAY-FOR-PERFORMANCE:
P4P Programs Not Reaching Small Physician Practices
Many physicians don't trust health plan-generated performance data.Despite the enthusiasm ... Read more
P4P POLICY:
P4P Standardization Is Key, Industry Leaders Agree
Quality reporting won't work unless Congress and CMS develop a national system, IOM says.P... Read more
INDUSTRY NOTES:
Hospital Wage Index May Not Accurately Reflect Occupational Mix
Reporting discrepancies could bias wages upward and distort adjustments.Proposed changes t... Read more
PART D:
Prescription Drug Plan Draws Meager Turnout From Low-Income Seniors
Advocacy groups criticize drug plan's complexity and propose new protections for bewildere... Read more
HEALTH IT:
Insurers Leading The Health Care Technology Charge
Health plans push innovations that improve quality, cost and effciency, survey finds.For a... Read more
COVERAGE:
Short-Term Commitment To Retiree Drug Plans Leaves Future Uncertain
Businesses' wait-and-see approach to reitiree drug coverage could be the calm before a sto... Read more
SNFs Could Face Hard Times Without a Market Basket Update
Recommendations for 2006 PPS changes offer big payment shifts but little assistance.The Me... Read more
INDUSTRY NOTES:
Motion To Warn Could Sway Budget Bill Conferees To Throw Out Medicaid Benefit Cuts
Plus: Scrutiny of Medicare QIOs intensifies.Just as the much-debated budget reconcili... Read more
PHYSICIANS:
New Appeals Rules Alter Almost Everything
Physicians must get up to speed before January rolls around.Starting Jan. 1, physicians wi... Read more
PHYSICIANS:
Knowledge Of LCDs Vital To 2006 Appeals
Practices that don't have good communication between departments could suffer.Physicians w... Read more
PHYSICIANS:
AMA, CMS, MedPAC Have Their Say On Medicare
Testimony flies from 3 sides as Congress strives to improve the program.In Washington, DC ... Read more
REHAB:
OT In Schools Could See A Boost
Pending bill would align with No Child Left Behind.Occupational therapists practicing in s... Read more
HEALTH INFORMATION TECHNOLOGY:
Senate Stresses Physician Incentives, EMR In IT Bill
Legislation part of continued effort to kick-start HIT adoption.The Senate approved the Wi... Read more
PHARMACEUTICALS:
FDA Stalled By Red Tape As Illegal Rx Market Booms
Limited data constricts FDA's quality control efforts over unlawful imports.The volume of ... Read more
PHARMACEUTICALS:
Critics Piling On CMS For Part D Web 'Tool'
Senior group also not thrilled with Part D in general.Yet another patient-advocacy group h... Read more
HOSPITALS:
CMS Tooting Its P4P Horn
Bonuses paid out for facilities that improve care quality. The Centers for Medicare and Me... Read more
ENFORCEMENT WATCH:
Ambulance Transports A Target For Investigators
Company gets caught altering medical documentation to justify claims.If patients' medical ... Read more
LONG-TERM CARE:
OIG Work Plan Puts More Scrutiny On LTC Facilities
Deficiency trends the top priority of OIG plan.A survey strike against you will be an incr... Read more
BILL WATCH
The following bills were introduced in the Senate: S. 2007. A bill to examine the circumst... Read more
Available Years:  2006  2005  2004  2003