Medicare Compliance & Reimbursement
Compliance:
OIG Reaps $20.4 Billion In Errors, Fraud This Year
Agency combing through everything from injections to consulting agreements. In its semian... Read more
OIG Reaps $20.4 Billion In Errors, Fraud This Year
Agency combing through everything from injections to consulting agreements. In its semian... Read more
Physical Therapy:
Canalith Repositioning Maneuvers Have A New Code
Medicare's recent reimbursement decision could affect you. CPT Codes has a New Years g... Read more
Canalith Repositioning Maneuvers Have A New Code
Medicare's recent reimbursement decision could affect you. CPT Codes has a New Years g... Read more
Reimbursement:
HHAs On MedPAC's Chopping Block
Advisory body favors cuts due to high HHA profit margins. The fight will be on in Congres... Read more
HHAs On MedPAC's Chopping Block
Advisory body favors cuts due to high HHA profit margins. The fight will be on in Congres... Read more
Consolidated Billing:
Find Your Way Through the SNF Billing Maze
Consult Stark and consolidated billing rules first. If your physician sees patients in a ... Read more
Find Your Way Through the SNF Billing Maze
Consult Stark and consolidated billing rules first. If your physician sees patients in a ... Read more
Coding Coach:
4 Groupings Will Streamline New Orthopedic Codes
CMS prices two new codes at over $1,000 -- will you recoup that pay? You can stop feeling... Read more
4 Groupings Will Streamline New Orthopedic Codes
CMS prices two new codes at over $1,000 -- will you recoup that pay? You can stop feeling... Read more
INDUSTRY NOTES :
Obama Expected to Name New CMS Chief Soon
Plus: CMS correcting errors, helping with e-prescribing incentive program. President-elect... Read more
Obama Expected to Name New CMS Chief Soon
Plus: CMS correcting errors, helping with e-prescribing incentive program. President-elect... Read more
Reader Question:
Don't Risk Pay! Verify The Location For Synvisc Coding
Caution: Some payers only reimburse these injections to the knee, while others might pay ... Read more
Don't Risk Pay! Verify The Location For Synvisc Coding
Caution: Some payers only reimburse these injections to the knee, while others might pay ... Read more
CPT 2009:
Correct These CPT 2009 Errors, AMA Instructs
Here's what you should delete and add. If you're scratching your head about some of the i... Read more
Correct These CPT 2009 Errors, AMA Instructs
Here's what you should delete and add. If you're scratching your head about some of the i... Read more
HIPAA:
OIG Wants CMS To Better Enforce Medical Security
The agency falls short in its oversight and enforcement, OIG reports. Authorities may not... Read more
OIG Wants CMS To Better Enforce Medical Security
The agency falls short in its oversight and enforcement, OIG reports. Authorities may not... Read more
2009 ICD-9 Manual:
Erase These Errors From Your Playbook
Think CPT contained the only errors? Wrong: ICD-9 has mistakes you should note, too... Read more
Erase These Errors From Your Playbook
Think CPT contained the only errors? Wrong: ICD-9 has mistakes you should note, too... Read more
CERT:
Medicare Focusing On Payment Errors
Medicare continues to pay providers more accurately, according to a new report. The impro... Read more
Medicare Focusing On Payment Errors
Medicare continues to pay providers more accurately, according to a new report. The impro... Read more
Prolonged Services:
Simple Steps To Bill Prolonged Services Without Modifier 21
3 steps help you keep your pay despite CPT's deletions. If you're used to adding modifier... Read more
Simple Steps To Bill Prolonged Services Without Modifier 21
3 steps help you keep your pay despite CPT's deletions. If you're used to adding modifier... Read more
Coding Coach:
Home In On CPT 2009's Coding Changes
Take heed: You won't find all of these changes in the 2009 CPT manual. Don't ... Read more
Home In On CPT 2009's Coding Changes
Take heed: You won't find all of these changes in the 2009 CPT manual. Don't ... Read more
Industry Notes:
Deductible No Longer Applies To 'Welcome to Medicare' Exam, CMS Says
Plus: CMS adds RVUs to immunization administration codes that reflect work preparin... Read more
Deductible No Longer Applies To 'Welcome to Medicare' Exam, CMS Says
Plus: CMS adds RVUs to immunization administration codes that reflect work preparin... Read more
IN OTHER NEWS
• You no longer have to think of clinical staff work preparing vaccines as a freebie se... Read more
• You no longer have to think of clinical staff work preparing vaccines as a freebie se... Read more
Reader Question:
Here's How To Code For Conversion To
CCI bundles laparoscopic portion into open code. Question: My doctor did a laparoscopic c... Read more
Here's How To Code For Conversion To
CCI bundles laparoscopic portion into open code. Question: My doctor did a laparoscopic c... Read more
Fee Schedule:
2009 Conversion Factor Lands At $36.066
But expect a 1.1 percent budget neutrality adjustment boost. The 2009 conversion factor... Read more
2009 Conversion Factor Lands At $36.066
But expect a 1.1 percent budget neutrality adjustment boost. The 2009 conversion factor... Read more
Reimbursement:
Feds' Fraud Fight Will Reduce Outlier Rate
CMS punts on wage index yet again. The 2009 home health agency rate update notice does co... Read more
Feds' Fraud Fight Will Reduce Outlier Rate
CMS punts on wage index yet again. The 2009 home health agency rate update notice does co... Read more
Icd-10:
Test Run Reveals ICD-10 Transition Won't Be Rocky
Plus: Physicians shouldn't have to bend over backward to change how they document t... Read more
Test Run Reveals ICD-10 Transition Won't Be Rocky
Plus: Physicians shouldn't have to bend over backward to change how they document t... Read more
Payments:
Florida Payers Pass Up Refunds After A Year
Here's how a new law is changing the state's overpayment rules. Yes, you should take paye... Read more
Florida Payers Pass Up Refunds After A Year
Here's how a new law is changing the state's overpayment rules. Yes, you should take paye... Read more
Coding Coach:
Use Of Sleep Staging Determines Sleep Test
Coding these procedures incorrectly could raise a red flag for auditors. Despite the simi... Read more
Use Of Sleep Staging Determines Sleep Test
Coding these procedures incorrectly could raise a red flag for auditors. Despite the simi... Read more
Industry Notes:
Medicare Owes Millions In Back Pay To Physicians
Plus: Hospices may get higher pay for beginning and end of patient's. Physicians in... Read more
Medicare Owes Millions In Back Pay To Physicians
Plus: Hospices may get higher pay for beginning and end of patient's. Physicians in... Read more
IN OTHER NEWS
•Your hospice payments could look a lot different if Congress heeds the new advice of a... Read more
•Your hospice payments could look a lot different if Congress heeds the new advice of a... Read more
Reader Question:
Here's How You Can Combat FluMist Denials
Stop denials before they start, you shouldn't report 90473 and 90471 together, CPT ... Read more
Here's How You Can Combat FluMist Denials
Stop denials before they start, you shouldn't report 90473 and 90471 together, CPT ... Read more
CPT 2009:
Get Ready For Two New Anesthesia Codes
Plus: New Category II code also changes the way you report cataract pre-op visit. CPT 2009... Read more
Get Ready For Two New Anesthesia Codes
Plus: New Category II code also changes the way you report cataract pre-op visit. CPT 2009... Read more
Fraud & Abuse:
OIG Sets Sights On DME Suppliers
Federal watchdog agency will investigate 20 different DME topics this year Poor documentat... Read more
OIG Sets Sights On DME Suppliers
Federal watchdog agency will investigate 20 different DME topics this year Poor documentat... Read more
Compliance:
OIG Gives OK To Outsourcing Pre-Authorizations
But beware any compensation that is based on commissions There's finally some good news fo... Read more
OIG Gives OK To Outsourcing Pre-Authorizations
But beware any compensation that is based on commissions There's finally some good news fo... Read more
Medicaid:
Medicaid Programs Are Paying More Than Their Share
OIG finds $873K in overpayments. State Medicaid programs are paying for more than 24 hours... Read more
Medicaid Programs Are Paying More Than Their Share
OIG finds $873K in overpayments. State Medicaid programs are paying for more than 24 hours... Read more
ICD-9:
Use OB Codes For Pregnant Patients' Complications
Test your documentation attentiveness with these ICD-9 examples. Subtle differences in you... Read more
Use OB Codes For Pregnant Patients' Complications
Test your documentation attentiveness with these ICD-9 examples. Subtle differences in you... Read more
Coding Coach:
Ace ACL Coding With 3 Can't Miss Tips
Knee surgeons starting to use pain pumps? Check question 3 As many as 300,000 Americans te... Read more
Ace ACL Coding With 3 Can't Miss Tips
Knee surgeons starting to use pain pumps? Check question 3 As many as 300,000 Americans te... Read more
Industry Notes:
Don't Forget About Category III Codes
Plus: AHIMA asks CMS for more time before moving to ICD-10. With all the discussion ... Read more
Don't Forget About Category III Codes
Plus: AHIMA asks CMS for more time before moving to ICD-10. With all the discussion ... Read more
Reader Question:
Here's How To Code Built-In Service With Separate Evaluation & Management
Warning: Brief history and review probably won't qualify for E/M code when your NP adminis... Read more
Here's How To Code Built-In Service With Separate Evaluation & Management
Warning: Brief history and review probably won't qualify for E/M code when your NP adminis... Read more
CMS Appoints 'Integrity Contractors' To Find Fraud
New Medicare program will zero in on aberrant billing trends in your claims. Just when you... Read more
New Medicare program will zero in on aberrant billing trends in your claims. Just when you... Read more
ICD-9 Quiz:
New ICD-9 Codes Are in Effect -- Are
Check out your diagnosis coding finesse with 5 quick ICD-9 cod Although the new edition of... Read more
New ICD-9 Codes Are in Effect -- Are
Check out your diagnosis coding finesse with 5 quick ICD-9 cod Although the new edition of... Read more
CPT Makes HPV Code Official; Radically Changes TURP Coding
CPT changes now allow you to use one code with a modifier for stages 1 and 2 of TURP. You... Read more
CPT changes now allow you to use one code with a modifier for stages 1 and 2 of TURP. You... Read more
Compliance:
CPT Adds New Canalith Repositioning Code, Allowing You to Ditch Unlisted Code for Epley
Plus: Several new surgical codes debut, but it's which codes are missing from CPT 2009 tha... Read more
CPT Adds New Canalith Repositioning Code, Allowing You to Ditch Unlisted Code for Epley
Plus: Several new surgical codes debut, but it's which codes are missing from CPT 2009 tha... Read more
Coding Coach:
ICD-9 Coding: Think 'Likely' Diagnosis Trumps Symptoms? Think Again
Look for these phrases in your physician's documentation. Typically, your first-listed ICD... Read more
ICD-9 Coding: Think 'Likely' Diagnosis Trumps Symptoms? Think Again
Look for these phrases in your physician's documentation. Typically, your first-listed ICD... Read more
Industry Notes:
ICD-10 Transition Could Cost $2 Million
Plus: CMS continues with competitive bidding for DME Transition to the ICD-10 diagnosis co... Read more
ICD-10 Transition Could Cost $2 Million
Plus: CMS continues with competitive bidding for DME Transition to the ICD-10 diagnosis co... Read more
Reader Question:
CMS Proposed Changing Payment Guidelines for Non-Credentialed Physicians
Under proposed plan, CMS would no longer allow retroactive billing for newly-credentialed ... Read more
CMS Proposed Changing Payment Guidelines for Non-Credentialed Physicians
Under proposed plan, CMS would no longer allow retroactive billing for newly-credentialed ... Read more
Fraud & Abuse:
Senate Wants Diagnosis Codes Linked To DME Claims
Report finds billions of dollars in questionable DME payments. Edits for durable medical ... Read more
Senate Wants Diagnosis Codes Linked To DME Claims
Report finds billions of dollars in questionable DME payments. Edits for durable medical ... Read more
ASC Payment:
CMS Confirms That Docs in ASCs Should Collect Facility Rate
In the past, Medicare paid ASCs the higher non-facility rate for non-covered procedures I... Read more
CMS Confirms That Docs in ASCs Should Collect Facility Rate
In the past, Medicare paid ASCs the higher non-facility rate for non-covered procedures I... Read more
Medical Edits:
CMS Finally Publishes Long-Awaited List of Medically Unnecessary Edits
Look to MUE list to find out how many units of any particular code your carrier wil... Read more
CMS Finally Publishes Long-Awaited List of Medically Unnecessary Edits
Look to MUE list to find out how many units of any particular code your carrier wil... Read more
Compliance:
OIG to Focus on Incident-to Services, Ultrasounds, Unlisted Procedures, And More in 2009
The OIG's 2009 Work Plan indicates that modifier GY, nonphysician practitioner pay, and o... Read more
OIG to Focus on Incident-to Services, Ultrasounds, Unlisted Procedures, And More in 2009
The OIG's 2009 Work Plan indicates that modifier GY, nonphysician practitioner pay, and o... Read more
Coding Coach:
Sidestep These 3 X-Ray Scenario Pitfalls
Supercharge your skills by knowing which guidelines to keep handy. Medical coders must be... Read more
Sidestep These 3 X-Ray Scenario Pitfalls
Supercharge your skills by knowing which guidelines to keep handy. Medical coders must be... Read more
Industry Notes:
DOJ Nails PA & Medical Biller In HIV Infusion Scam
Plus: Soon physicians won't need accreditation to supply DME. If you think the gove... Read more
DOJ Nails PA & Medical Biller In HIV Infusion Scam
Plus: Soon physicians won't need accreditation to supply DME. If you think the gove... Read more
Reader Question:
Documentation Distinguishes Consult
Keep an eye on "consult and treat" requests. Question: What's the difference between a co... Read more
Documentation Distinguishes Consult
Keep an eye on "consult and treat" requests. Question: What's the difference between a co... Read more
Part B Mythbuster:
What Constitutes 'Lavage?' It May Be More Than You Think
What to watch to avoid a crucial $500 (or more) mistake. Myth: If your surgeo... Read more
What Constitutes 'Lavage?' It May Be More Than You Think
What to watch to avoid a crucial $500 (or more) mistake. Myth: If your surgeo... Read more
Documentation:
CMS Offers You An Extra 6 Months To Prepare For New ABN
Effective March 1, labs and physician practices must use the new combined ABN/NEMB. The S... Read more
CMS Offers You An Extra 6 Months To Prepare For New ABN
Effective March 1, labs and physician practices must use the new combined ABN/NEMB. The S... Read more
CCI:
CCI Bundles Moderate Sedation Into Scores of Surgery Codes
Plus: The new version of CCI also swaps several code pairs. CCI Version 14.3 blasts... Read more
CCI Bundles Moderate Sedation Into Scores of Surgery Codes
Plus: The new version of CCI also swaps several code pairs. CCI Version 14.3 blasts... Read more
Compliance:
OIG Finds 63-Percent Error Rate on Facet Joint Injections -- Here's How to Avoid Problems
Hint: Bilateral injection errors accounted for scores of issues. According to a Sep... Read more
OIG Finds 63-Percent Error Rate on Facet Joint Injections -- Here's How to Avoid Problems
Hint: Bilateral injection errors accounted for scores of issues. According to a Sep... Read more
Coding Coach:
What Qualifies As 'More Extensive?' Find Out Now
If same condition prompts initial and follow-up procedures, 58 applies. The AMA revised C... Read more
What Qualifies As 'More Extensive?' Find Out Now
If same condition prompts initial and follow-up procedures, 58 applies. The AMA revised C... Read more
Idustry Notes:
21 Lab Tests Approved For CLIA-Waived Status
Plus: Get ready for mass immunization season. Effective Oct. 1, you'll have a host ... Read more
21 Lab Tests Approved For CLIA-Waived Status
Plus: Get ready for mass immunization season. Effective Oct. 1, you'll have a host ... Read more
Reader Question:
Physician Leading CPR Can Report 92950, As Well As E/M, If Applicable
Emergency defibrillation, however, is probably not billable along with the CPR, so don't ... Read more
Physician Leading CPR Can Report 92950, As Well As E/M, If Applicable
Emergency defibrillation, however, is probably not billable along with the CPR, so don't ... Read more
Fraud & Abuse:
Firestorm Erupts When CMS Lowballs DME Error Rate
Suppliers are caught in the crossfire between CMS, OIG, and politicians. Suppliers can ex... Read more
Firestorm Erupts When CMS Lowballs DME Error Rate
Suppliers are caught in the crossfire between CMS, OIG, and politicians. Suppliers can ex... Read more
Medical review:
These OIG Recommendations May Make Life Harder
CMS will toughen up scrutiny for diabetic test strips, oxygen, and wheelchairs. After bei... Read more
These OIG Recommendations May Make Life Harder
CMS will toughen up scrutiny for diabetic test strips, oxygen, and wheelchairs. After bei... Read more
Reimbursement:
Part B QICs Missed 68 Percent Of Appeals Deadlines, OIG Says Deadlines, OIG Says
And 54 percent of both Part A and Part B QIC appeals included wrong info. If you've been ... Read more
Part B QICs Missed 68 Percent Of Appeals Deadlines, OIG Says Deadlines, OIG Says
And 54 percent of both Part A and Part B QIC appeals included wrong info. If you've been ... Read more
Documentation:
CMS: Physician Signature Not Required for Diagnostic Tests
New clarification trumps previous advice. In an attempt to clear up confusion about who c... Read more
CMS: Physician Signature Not Required for Diagnostic Tests
New clarification trumps previous advice. In an attempt to clear up confusion about who c... Read more
Compliance:
OIG Warns About Leasing Space to Other Physicians
Be mindful of anti-kickback rules when leasing space. You own a cancer center where your ... Read more
OIG Warns About Leasing Space to Other Physicians
Be mindful of anti-kickback rules when leasing space. You own a cancer center where your ... Read more
Coding Coach:
Split Professional, Technical Components With Ease
Purchasing power will change the rules for modifiers 26, TC. Reporting modifiers 26 (Prof... Read more
Split Professional, Technical Components With Ease
Purchasing power will change the rules for modifiers 26, TC. Reporting modifiers 26 (Prof... Read more
Industry Notes:
Providers Not Very Happy With Medicare Contractors
RHHIs score the best. Durable medical equipment suppliers are the least happy of all Medi... Read more
Providers Not Very Happy With Medicare Contractors
RHHIs score the best. Durable medical equipment suppliers are the least happy of all Medi... Read more
Reader Question:
HHAs Won't Get Full Episode Payment For MA Patients
You'll have to hand back payments you've received in error, a CMS official warns. Questio... Read more
HHAs Won't Get Full Episode Payment For MA Patients
You'll have to hand back payments you've received in error, a CMS official warns. Questio... Read more
Pay for Performance:
You Don't Have To Sacrifice Quality Care To Save Money
CMS's first P4P project payed off in a big way Better treatment needn't necessarily come ... Read more
You Don't Have To Sacrifice Quality Care To Save Money
CMS's first P4P project payed off in a big way Better treatment needn't necessarily come ... Read more
Part B:
New Therapy Assessment Tool On Its Way
Your Part B therapy payments may soon resemble OASIS and PPS Yearning for the day when th... Read more
New Therapy Assessment Tool On Its Way
Your Part B therapy payments may soon resemble OASIS and PPS Yearning for the day when th... Read more
Modifier Errors:
Save Your Reimbursement By Putting A Stop To Modifier 59 Misuse
Practices to heed the rules when using modifier 59 to separate CCI edits -- or else, carr... Read more
Save Your Reimbursement By Putting A Stop To Modifier 59 Misuse
Practices to heed the rules when using modifier 59 to separate CCI edits -- or else, carr... Read more
Modifier Errors:
Map Out Your Modifier Decisions To Avoid Payer Penalties
Your physician performs two separate procedures that are bundled together under the Correc... Read more
Map Out Your Modifier Decisions To Avoid Payer Penalties
Your physician performs two separate procedures that are bundled together under the Correc... Read more
Coding Coach:
Clear Up Your Modifer 25 E/M Confusion
Keep E/M documentation apart to demonstrate the service's 'separate' status To report an ... Read more
Clear Up Your Modifer 25 E/M Confusion
Keep E/M documentation apart to demonstrate the service's 'separate' status To report an ... Read more
Industry Notes:
ICD-10 Transition May Be Only A Few Years Away
Plus: CMS busted for 'cooking books' You've got just over a month left before you n... Read more
ICD-10 Transition May Be Only A Few Years Away
Plus: CMS busted for 'cooking books' You've got just over a month left before you n... Read more
Reader Question:
Be Careful When Sharing Medicare Savings
An advisory opinion reiterates that OIG will impose civil monetary penalties Question: Ma... Read more
Be Careful When Sharing Medicare Savings
An advisory opinion reiterates that OIG will impose civil monetary penalties Question: Ma... Read more
HOSPITALS:
Look For Longer List Of 'Never Events' From CMS
The goal: reducing preventable medical errors. Hospitals just getting a handle on m... Read more
Look For Longer List Of 'Never Events' From CMS
The goal: reducing preventable medical errors. Hospitals just getting a handle on m... Read more
Compliance:
Follow 6 Steps To Shore Up HIPAA Compliance
Don't let harsher enforcement catch you by surprise. If your HIPAA compliance has gathere... Read more
Follow 6 Steps To Shore Up HIPAA Compliance
Don't let harsher enforcement catch you by surprise. If your HIPAA compliance has gathere... Read more
Home Health:
Prepare For These Medicare Advantage Changes
MA provisions in MIPPA legislation presents pros and cons for HHAs. In the re... Read more
Prepare For These Medicare Advantage Changes
MA provisions in MIPPA legislation presents pros and cons for HHAs. In the re... Read more
Part B Claims:
Non-Par Providers Must Submit Claims On Patient's Behalf
Those who opt out may not be subject to claim filing. So, you've decided to no longer par... Read more
Non-Par Providers Must Submit Claims On Patient's Behalf
Those who opt out may not be subject to claim filing. So, you've decided to no longer par... Read more
Coding Coach:
Scope Out 5 Can't-Miss Tips For ACL Coding
Knee surgeons starting to use pain pumps? Check question 3. As many as 300,000 Amer... Read more
Scope Out 5 Can't-Miss Tips For ACL Coding
Knee surgeons starting to use pain pumps? Check question 3. As many as 300,000 Amer... Read more
Industry Notes:
CMS Gets Tough On Cost Reporting
Plus: Only 10 percent of ALJ hearings take place in person -- and medical pra... Read more
CMS Gets Tough On Cost Reporting
Plus: Only 10 percent of ALJ hearings take place in person -- and medical pra... Read more
Reader Question:
Don't Let Billers Add Services To Claims Without Permission
Only report what shows on the encounter superbill. Question: Our office uses an outside b... Read more
Don't Let Billers Add Services To Claims Without Permission
Only report what shows on the encounter superbill. Question: Our office uses an outside b... Read more
Appeals:
Part B QICs Missed 58 Percent Of Appeals Deadlines
54 percent of QIC appeals included wrong information, OIG says. If you've been rely... Read more
Part B QICs Missed 58 Percent Of Appeals Deadlines
54 percent of QIC appeals included wrong information, OIG says. If you've been rely... Read more
Appeals:
Stay On Top Of Appeals Process With These Quick Tips
5 steps may keep you from suffering a denial and forfeiting your due reimbursement. The g... Read more
Stay On Top Of Appeals Process With These Quick Tips
5 steps may keep you from suffering a denial and forfeiting your due reimbursement. The g... Read more
Home Care:
Ensure Home Care Therapists Understand New Requirements
PTs, PTAs, OTs and OTAs have a slew of new Medicare standards. You aren't alone if you've... Read more
Ensure Home Care Therapists Understand New Requirements
PTs, PTAs, OTs and OTAs have a slew of new Medicare standards. You aren't alone if you've... Read more
Nursing Homes:
Learn Ins And Outs Of CMS' Nursing Home Star Ratings
Rise and shine: Don't let this latest effort to quantify nursing home quality get y... Read more
Learn Ins And Outs Of CMS' Nursing Home Star Ratings
Rise and shine: Don't let this latest effort to quantify nursing home quality get y... Read more
Coding Coach:
Are You Ready For These 3 Cataract Coding Scenarios?
Surgery on both eyes on different dates means 2 global periods. It's not always easy to k... Read more
Are You Ready For These 3 Cataract Coding Scenarios?
Surgery on both eyes on different dates means 2 global periods. It's not always easy to k... Read more
Industry Notes:
MedPAC Releases View Of Average Medicare Patient
Plus: HIPAA violation of $100,000 stuns health plan. If you've ever wondered ... Read more
MedPAC Releases View Of Average Medicare Patient
Plus: HIPAA violation of $100,000 stuns health plan. If you've ever wondered ... Read more
Reader Question:
Medicare Considers Interpreter's Service 'Incidental'
Question: Which diagnosis code should I use with T1013 for using an interpreter? Answer:... Read more
Medicare Considers Interpreter's Service 'Incidental'
Question: Which diagnosis code should I use with T1013 for using an interpreter? Answer:... Read more
Part B Payment:
Senate Votes To Avert Medicare Pay Cut For 18 Months
Congress swiftly overrides presidential veto You're getting closer to a short-term soluti... Read more
Senate Votes To Avert Medicare Pay Cut For 18 Months
Congress swiftly overrides presidential veto You're getting closer to a short-term soluti... Read more
Fee Schedule:
2009 Fee Schedule Proposes 5.4 Percent Cut To Medicare Pay
CMS wants comments on the proposal by Aug. 29 While lawmakers attempt to heal the p... Read more
2009 Fee Schedule Proposes 5.4 Percent Cut To Medicare Pay
CMS wants comments on the proposal by Aug. 29 While lawmakers attempt to heal the p... Read more
Compliance:
OIG Okays Gift Cards For Unhappy Patients
But the Office of Inspector General questions excluding ordering doc's NPI on claim... Read more
OIG Okays Gift Cards For Unhappy Patients
But the Office of Inspector General questions excluding ordering doc's NPI on claim... Read more
Hospice:
New Reporting Could Delay Hospice Cash Flow
Claims data requirement hit hospices on July 1 Hospices are better prepared to tackle the... Read more
New Reporting Could Delay Hospice Cash Flow
Claims data requirement hit hospices on July 1 Hospices are better prepared to tackle the... Read more
Coding Coach:
Get The Skinny On 2009 Migraine Codes Now To Avoid October Denials
ICD-9 plans more specific options for chronic migraines, status migraines and more You ma... Read more
Get The Skinny On 2009 Migraine Codes Now To Avoid October Denials
ICD-9 plans more specific options for chronic migraines, status migraines and more You ma... Read more
Studies And Reports:
Infectious Diseases Going Undiagnosed And Untreated
Hundreds of thousands of low-income residents of inner cities of the United States, the M... Read more
Infectious Diseases Going Undiagnosed And Untreated
Hundreds of thousands of low-income residents of inner cities of the United States, the M... Read more
Industry Notes:
Don't Submit Modifier KX For Therapy Services
Plus: OIG finds massive overbilling of some cancer drug units Legislators may... Read more
Don't Submit Modifier KX For Therapy Services
Plus: OIG finds massive overbilling of some cancer drug units Legislators may... Read more
Reader Question:
Learn Foolproof Drug Wastage Calculation
CMS offers guidance for this tricky task Question: When we code for drug wastage, I... Read more
Learn Foolproof Drug Wastage Calculation
CMS offers guidance for this tricky task Question: When we code for drug wastage, I... Read more
Part B Payment:
CMS Delays Pay Cuts Until After July 15
Bill may return after July 4 recess. The Centers for Medicare & Medicaid Services has... Read more
CMS Delays Pay Cuts Until After July 15
Bill may return after July 4 recess. The Centers for Medicare & Medicaid Services has... Read more
Labs:
Travel Allowance For Fee Collection Benefits Labs That Bill Part B
Remember: Medicare will pay a travel allowance to draw specimens from nursing home ... Read more
Travel Allowance For Fee Collection Benefits Labs That Bill Part B
Remember: Medicare will pay a travel allowance to draw specimens from nursing home ... Read more
Revenue Booster:
3 Tips Sharpen Your Unlisted Coding Finesse
Don't forget to compare your unlisted procedure to an existing code. You can streamline y... Read more
3 Tips Sharpen Your Unlisted Coding Finesse
Don't forget to compare your unlisted procedure to an existing code. You can streamline y... Read more
Compliance:
Take These Steps To Steer Visitors Away From PHI
You can open your organization to visitors -- here's how. Whether you allow anyone to loo... Read more
Take These Steps To Steer Visitors Away From PHI
You can open your organization to visitors -- here's how. Whether you allow anyone to loo... Read more
Competitive Bidding:
CMS' Bidding Letters Confuse Beneficiaries
One bidding lawsuit bites the dust. The feds continue to move forward with the July 1 imp... Read more
CMS' Bidding Letters Confuse Beneficiaries
One bidding lawsuit bites the dust. The feds continue to move forward with the July 1 imp... Read more
Coding Coach:
Heed New Transmittal When Documenting, Compiling Critical Care Time
Medicare clears up counseling, concurrent care rules. If coders can learn to spot crit... Read more
Heed New Transmittal When Documenting, Compiling Critical Care Time
Medicare clears up counseling, concurrent care rules. If coders can learn to spot crit... Read more
Industry Notes:
Add 4 Codes To Payable ASC List
Plus: House of Representatives aims to streamline health information technology sys... Read more
Add 4 Codes To Payable ASC List
Plus: House of Representatives aims to streamline health information technology sys... Read more
Reader Question:
Look To CPT For Advice When Patient History Is Unobtainable
CPT offers definitive guidance on computing history for patients who can't communic... Read more
Look To CPT For Advice When Patient History Is Unobtainable
CPT offers definitive guidance on computing history for patients who can't communic... Read more
PQRI:
Start Looking For Those PQRI Checks Very Soon
You reported your PQRI measures -- now reap the benefits. If you thought PQRI was a... Read more
Start Looking For Those PQRI Checks Very Soon
You reported your PQRI measures -- now reap the benefits. If you thought PQRI was a... Read more
Disaster Relief:
HHS Relaxes Medicare Requirements For Flood Areas
Healthcare providers fighting to serve Medicare patients in flooded areas are receiving so... Read more
HHS Relaxes Medicare Requirements For Flood Areas
Healthcare providers fighting to serve Medicare patients in flooded areas are receiving so... Read more
CCI Edits:
Version 14.2 Halts Payment Of 90769 With Several E/M Codes
Half of the new edit pairs affect anesthesiologists. The Correct Coding Initiative (CCI) ... Read more
Version 14.2 Halts Payment Of 90769 With Several E/M Codes
Half of the new edit pairs affect anesthesiologists. The Correct Coding Initiative (CCI) ... Read more
Medicare:
CMS Lauds Program That Raises Hospital Quality
Third year of demonstration project shows big improvement in inpatient care. Hospitals th... Read more
CMS Lauds Program That Raises Hospital Quality
Third year of demonstration project shows big improvement in inpatient care. Hospitals th... Read more
Coding Coach:
Prolonged-Services Switch Just Around The Corner
Learn how these CMS changes will affect your E/M coding and reimbursement. Coding f... Read more
Prolonged-Services Switch Just Around The Corner
Learn how these CMS changes will affect your E/M coding and reimbursement. Coding f... Read more
Compliance:
OIG Saves Medicare $2.2 Billion Over 6 Months
With 1,291 exclusions and 293 criminal actions, the OIG cracked down. According to ... Read more
OIG Saves Medicare $2.2 Billion Over 6 Months
With 1,291 exclusions and 293 criminal actions, the OIG cracked down. According to ... Read more
Industry Notes:
Lawmakers Are Still Furiously Working To Fix The 10 Percent Pay Cut Due July 1
Plus: Fight PTA denials based on expired facility certification. Political po... Read more
Lawmakers Are Still Furiously Working To Fix The 10 Percent Pay Cut Due July 1
Plus: Fight PTA denials based on expired facility certification. Political po... Read more
Reader Question:
CPT Accounts For Price Of 'Pill Cam' In Procedure Codes
Choose between 91110 and 91111 for appropriate payment. Question: What can you tell me ab... Read more
CPT Accounts For Price Of 'Pill Cam' In Procedure Codes
Choose between 91110 and 91111 for appropriate payment. Question: What can you tell me ab... Read more
Transmittals:
CMS Halts Bilateral Payment For Certain Procedures
Plus: Medicare debuts several new codes If you've become accustomed to collecting a... Read more
CMS Halts Bilateral Payment For Certain Procedures
Plus: Medicare debuts several new codes If you've become accustomed to collecting a... Read more
Public Health:
HHS Handing Out Big Bucks For Medical Emergencies
$1.1 billion will improve healthcare providers' response to terrorism, pandemics The Depa... Read more
HHS Handing Out Big Bucks For Medical Emergencies
$1.1 billion will improve healthcare providers' response to terrorism, pandemics The Depa... Read more
Budget:
Medicare Bill Takes Aim At Oxygen, Wheelchairs
Home health agency and hospice payments are safe, for now Politicians in Washington, DC a... Read more
Medicare Bill Takes Aim At Oxygen, Wheelchairs
Home health agency and hospice payments are safe, for now Politicians in Washington, DC a... Read more
Revenue Booster:
Nail Down Acronyms To Code Charts Properly Every Time
Would you be able to count E/M bullets properly if the physician wrote 'WBC/WNL'? If you ... Read more
Nail Down Acronyms To Code Charts Properly Every Time
Would you be able to count E/M bullets properly if the physician wrote 'WBC/WNL'? If you ... Read more
Health IT:
Communities Join Electronic Health Record Demo Project
Selected practices to get cash rewards up to $290,000 Department of Health and Human Serv... Read more
Communities Join Electronic Health Record Demo Project
Selected practices to get cash rewards up to $290,000 Department of Health and Human Serv... Read more
Coding Coach:
Vascular Family Matters For Catheter Coding
Not every vessel the surgeon crosses deserves a code Vascular coding basics tell you not ... Read more
Vascular Family Matters For Catheter Coding
Not every vessel the surgeon crosses deserves a code Vascular coding basics tell you not ... Read more
Rehab Providers:
Perfect What You Know About Certifications
Plus: Your progress report deadlines aren't what they used to be When the Medicare ... Read more
Perfect What You Know About Certifications
Plus: Your progress report deadlines aren't what they used to be When the Medicare ... Read more
Industry Notes:
It's Not Too Late To Participate In PQRI
Envious of the 1.5 percent bonuses? You can join the program as of July 1 If you haven't ... Read more
It's Not Too Late To Participate In PQRI
Envious of the 1.5 percent bonuses? You can join the program as of July 1 If you haven't ... Read more
Reader Question:
Check These Rules Before Billing For Stitch Removal
You must differentiate between simple post-op removal and more complex procedures Questio... Read more
Check These Rules Before Billing For Stitch Removal
You must differentiate between simple post-op removal and more complex procedures Questio... Read more
Compliance:
OIG Revisits Recommendation To Institute Edits
Office of Inspector General found 40 percent error rate on modifier 59 claims When ... Read more
OIG Revisits Recommendation To Institute Edits
Office of Inspector General found 40 percent error rate on modifier 59 claims When ... Read more
Transmittals:
No Plans To Replace Recent Incident-To Advice From CMS
With the new guidelines just about to take effect, CMS scraps Transmittal 87 If you... Read more
No Plans To Replace Recent Incident-To Advice From CMS
With the new guidelines just about to take effect, CMS scraps Transmittal 87 If you... Read more
Modifiers:
Follow Medicare's New Nerve Injection Modifier Rules
CMS changes could put more money in your pocket As every coder knows, CMS updates c... Read more
Follow Medicare's New Nerve Injection Modifier Rules
CMS changes could put more money in your pocket As every coder knows, CMS updates c... Read more
Medicare Errors:
SPECT Coding Tops CMS List Of 'No Documentation' Errors
CMS overpaid $15.2 million last year for 78465 -- here's how to avoid common mistak... Read more
SPECT Coding Tops CMS List Of 'No Documentation' Errors
CMS overpaid $15.2 million last year for 78465 -- here's how to avoid common mistak... Read more
Coding Coach:
Take Guesswork Out Of Coding For Teaching Physicians
Here's which modifier to use for the primary-care exception You can ensure that your phys... Read more
Take Guesswork Out Of Coding For Teaching Physicians
Here's which modifier to use for the primary-care exception You can ensure that your phys... Read more
Hospice:
New Regulation Clarifies Rights Of Hospice Patients
Changes in end-of-life care necessitated the overhaul The Centers for Medicare & Medi... Read more
New Regulation Clarifies Rights Of Hospice Patients
Changes in end-of-life care necessitated the overhaul The Centers for Medicare & Medi... Read more
Industry Notes:
Advisory Opinion Approves Hospital's Software That Communicates With Physicians' EHRs
Plus: Practitioners in S. Florida made up 20 percent of Medicare fraud cases When i... Read more
Advisory Opinion Approves Hospital's Software That Communicates With Physicians' EHRs
Plus: Practitioners in S. Florida made up 20 percent of Medicare fraud cases When i... Read more
Reader Question:
Zoom In On 'Targets' Before Coding Moderate Sedation
Hint: You can't always bill moderate sedation separately Question: An established p... Read more
Zoom In On 'Targets' Before Coding Moderate Sedation
Hint: You can't always bill moderate sedation separately Question: An established p... Read more
Medicare Errors:
Documentation Errors Cost Practices $1.3 Billion In 2007
Total error rate topped $10.2 billion Can't get your physician to document thoroughly? Th... Read more
Documentation Errors Cost Practices $1.3 Billion In 2007
Total error rate topped $10.2 billion Can't get your physician to document thoroughly? Th... Read more
Senior Care:
Coalition Says New Rule Undercuts Eldercare Improvements
$5 billion cut could put care needs of nursing home patients at risk A newly issued Cente... Read more
Coalition Says New Rule Undercuts Eldercare Improvements
$5 billion cut could put care needs of nursing home patients at risk A newly issued Cente... Read more
Therapy Regs:
CMS Report Reveals Win-Win Situation For Exceptions Process
Alternative to cap moratorium may be a viable long-term solution, experts say If you prov... Read more
CMS Report Reveals Win-Win Situation For Exceptions Process
Alternative to cap moratorium may be a viable long-term solution, experts say If you prov... Read more
Documentation:
Record Addendums Acceptable -- Most Of The Time
Ensure that the physician isn't amending the record just to get the claim paid Imagine th... Read more
Record Addendums Acceptable -- Most Of The Time
Ensure that the physician isn't amending the record just to get the claim paid Imagine th... Read more
Safety:
Initiative Aims To Create A 'Sentinel' For Healthcare Products
Electronic system will include a huge database for research, oversight and evaluation The... Read more
Initiative Aims To Create A 'Sentinel' For Healthcare Products
Electronic system will include a huge database for research, oversight and evaluation The... Read more
Coding Coach:
Don't Let Time-Limit Myth Restrict Your Consultation Options
Know when you can report a repeat consultation -- and when you can't If you're a speciali... Read more
Don't Let Time-Limit Myth Restrict Your Consultation Options
Know when you can report a repeat consultation -- and when you can't If you're a speciali... Read more
Industry Notes:
More Than 500 CPT Changes Will Take Effect In January, But AMA Hasn't Revealed Specific Codes Yet
Plus: Hospices interested in participating in the Medicare program must heed new rules Wh... Read more
More Than 500 CPT Changes Will Take Effect In January, But AMA Hasn't Revealed Specific Codes Yet
Plus: Hospices interested in participating in the Medicare program must heed new rules Wh... Read more
Reader Question:
Know HPV Coverage Rules When Billing For The Lab's Side
Hint: Report 795.05 only when the test is positive Question: I am in a laboratory setting... Read more
Know HPV Coverage Rules When Billing For The Lab's Side
Hint: Report 795.05 only when the test is positive Question: I am in a laboratory setting... Read more
Legislation:
Congress Agrees On 2009 Budget Without Medicare Cuts
Plan would create budget surplus by 2012 -- but June '08 Medicare cuts are left hanging L... Read more
Congress Agrees On 2009 Budget Without Medicare Cuts
Plan would create budget surplus by 2012 -- but June '08 Medicare cuts are left hanging L... Read more
Compliance:
Handle Medicare Audits With These 5 Steps
Be proactive to avoid audits -- but if all else fails, remain professional This year, hun... Read more
Handle Medicare Audits With These 5 Steps
Be proactive to avoid audits -- but if all else fails, remain professional This year, hun... Read more
Patient Notices:
Use New ABN Forms For DME, Hospice
Grace period for CMS' updated, revised ABN ends Sept. 1 If you still struggle with unders... Read more
Use New ABN Forms For DME, Hospice
Grace period for CMS' updated, revised ABN ends Sept. 1 If you still struggle with unders... Read more
Part B Payment:
Demo Program Bundles Physician's Pay With Hospital's
Certain cardiac, orthopedic services targeted first in the 4 participating states If you ... Read more
Demo Program Bundles Physician's Pay With Hospital's
Certain cardiac, orthopedic services targeted first in the 4 participating states If you ... Read more
Coding Coach:
Prepare For Pain Management Diagnosis Coding Changes
You may have to leave your 784.0 comfort zone in October ICD-9 2009 may include more new ... Read more
Prepare For Pain Management Diagnosis Coding Changes
You may have to leave your 784.0 comfort zone in October ICD-9 2009 may include more new ... Read more
Fraud:
Fraud 'Strike Force' Targets Southern California
More than 100 cases of billing fraud already exposed in Florida The multi-agency fraud "s... Read more
Fraud 'Strike Force' Targets Southern California
More than 100 cases of billing fraud already exposed in Florida The multi-agency fraud "s... Read more
Industry Notes:
NPI-Only Date Is Here -- Get Your Claims On Track
Plus: New DME competitive bidding awardees announced for 10 communities Get ready for den... Read more
NPI-Only Date Is Here -- Get Your Claims On Track
Plus: New DME competitive bidding awardees announced for 10 communities Get ready for den... Read more
Reader Question:
New CCI Verbiage Shouldn't Constrain Your Modifier Use
Version 13.3's introductory notes confused physicians, but we've got clarification Questi... Read more
New CCI Verbiage Shouldn't Constrain Your Modifier Use
Version 13.3's introductory notes confused physicians, but we've got clarification Questi... Read more
Medicare Advantage:
CMS To Tighten Protections For Medicare Advantage
Agency proposes $25,000 penalty per enrollee for plans that violate standards The Centers... Read more
CMS To Tighten Protections For Medicare Advantage
Agency proposes $25,000 penalty per enrollee for plans that violate standards The Centers... Read more
Billing:
Medicare Offers Updated Physical Therapy Coding And Billing Rules
Personnel qualifications, policies change in Transmittal 88 If you thought CMS' therapy b... Read more
Medicare Offers Updated Physical Therapy Coding And Billing Rules
Personnel qualifications, policies change in Transmittal 88 If you thought CMS' therapy b... Read more
Coding Coach:
Capture Urine Culture Payment With These Best Practices
If you're just assigning 87086 to every culture, you could be losing $3 per test Urine cu... Read more
Capture Urine Culture Payment With These Best Practices
If you're just assigning 87086 to every culture, you could be losing $3 per test Urine cu... Read more
SCHIP:
Administrator Clarifies SCHIP Policy For States
Previous message was unclear, officials say Centers for Medicare & Medicaid Services ... Read more
Administrator Clarifies SCHIP Policy For States
Previous message was unclear, officials say Centers for Medicare & Medicaid Services ... Read more
Compliance:
Labs Offering Favors May Violate Anti-Kickback Rules
Simply labeling test tubes on behalf of a dialysis facility could be going too far, the O... Read more
Labs Offering Favors May Violate Anti-Kickback Rules
Simply labeling test tubes on behalf of a dialysis facility could be going too far, the O... Read more
Competitive Bidding:
DME Suppliers Besiege Congress
House hearing puts CMS on the defensive as companies step up their campaign Durable medic... Read more
DME Suppliers Besiege Congress
House hearing puts CMS on the defensive as companies step up their campaign Durable medic... Read more
Industry Notes:
CMS Takes Strong Stance On New Intracranial Stenting And Angioplasty Device
Plus: New DME competitive bidding program advice adds meat to Medicare's Claims Processin... Read more
CMS Takes Strong Stance On New Intracranial Stenting And Angioplasty Device
Plus: New DME competitive bidding program advice adds meat to Medicare's Claims Processin... Read more
Reader Question:
Zoom In On Fluorescein Use When Treating Corneal Abrasions
Hint: Billing for a fluorescein stain is usually included as part of E/M service Question... Read more
Zoom In On Fluorescein Use When Treating Corneal Abrasions
Hint: Billing for a fluorescein stain is usually included as part of E/M service Question... Read more
Funding:
HHS Leader: Medicare Is 'Drifting To Disaster'
Program needs urgent changes now, secretary says Health & Human Services Secretary Mi... Read more
HHS Leader: Medicare Is 'Drifting To Disaster'
Program needs urgent changes now, secretary says Health & Human Services Secretary Mi... Read more
Coding Coach:
Decide Laceration Repair Level With Instrumentation, Depth
Hint: Anatomic classifications get smaller as repairs get more complex On your laceration... Read more
Decide Laceration Repair Level With Instrumentation, Depth
Hint: Anatomic classifications get smaller as repairs get more complex On your laceration... Read more
NPI:
CMS Stresses NPI-Only Date
Agency will hold 2 Q&A roundtables in May Medicare is now receiving more than 98 perc... Read more
CMS Stresses NPI-Only Date
Agency will hold 2 Q&A roundtables in May Medicare is now receiving more than 98 perc... Read more
Revenue Booster:
Don't Give Up On Pre- Or Postop Observation Care Payment
Keep an eye on modifier choice If you've been eating the cost of preoperative observation... Read more
Don't Give Up On Pre- Or Postop Observation Care Payment
Keep an eye on modifier choice If you've been eating the cost of preoperative observation... Read more
Part B Mythbuster:
Device Maker Offering To Appeal For You? Not So Fast
Consider the more conservative approach of the manufacturer guiding your appeal Myth: You... Read more
Device Maker Offering To Appeal For You? Not So Fast
Consider the more conservative approach of the manufacturer guiding your appeal Myth: You... Read more
Coverage:
Don't Expect Coverage For DNA Stool Tests
For cancer screening, stick to FOBT instead, advises CMS If your physician is one of the ... Read more
Don't Expect Coverage For DNA Stool Tests
For cancer screening, stick to FOBT instead, advises CMS If your physician is one of the ... Read more
Industry Notes:
CMS Updates Incident-To Regs -- NPPs Take Note
Plus: Lawmakers plan legislation to save Medicare payment cuts for early June If you've b... Read more
CMS Updates Incident-To Regs -- NPPs Take Note
Plus: Lawmakers plan legislation to save Medicare payment cuts for early June If you've b... Read more
Competitive Bidding:
Industry Continues Fight Against Round One Bidding
Examples of bidding errors are piling up Suppliers disheartened by round one of Medicare'... Read more
Industry Continues Fight Against Round One Bidding
Examples of bidding errors are piling up Suppliers disheartened by round one of Medicare'... Read more
Federal budget:
Medicare Trustees' Report Shows Need For Reform
The sooner financing problems are addressed, the more flexible the solutions can be The m... Read more
Medicare Trustees' Report Shows Need For Reform
The sooner financing problems are addressed, the more flexible the solutions can be The m... Read more
Health IT:
Deadline Looms For Medicare's EHR Demonstration Project
Act fast to apply to this P4P program CMS is so hopeful that more health practices will a... Read more
Deadline Looms For Medicare's EHR Demonstration Project
Act fast to apply to this P4P program CMS is so hopeful that more health practices will a... Read more
Billing:
Boost Efficiency And Speed Reimbursement With RTCA
Several payers are offering real-time claims adjudication -- are you taking advantage You... Read more
Boost Efficiency And Speed Reimbursement With RTCA
Several payers are offering real-time claims adjudication -- are you taking advantage You... Read more
Transmittals:
Physicians Can Bill For Prolonged E/M In Nursing Facilities
After years of having to eat the cost of these services, you're in the clear to collect M... Read more
Physicians Can Bill For Prolonged E/M In Nursing Facilities
After years of having to eat the cost of these services, you're in the clear to collect M... Read more
Coding Coach:
Follow 4 Tips To Combine Burns For Diagnosis Coding
Fourth, fifth digits are vital to these ICD-9 codes To accurately code diagnoses for pati... Read more
Follow 4 Tips To Combine Burns For Diagnosis Coding
Fourth, fifth digits are vital to these ICD-9 codes To accurately code diagnoses for pati... Read more
OIG:
Office Of Inspector General Joins The Digital Age
Seeks efficiency through electronic payments The Office of Inspector General has changed ... Read more
Office Of Inspector General Joins The Digital Age
Seeks efficiency through electronic payments The Office of Inspector General has changed ... Read more
Industry Notes:
CMS Clarifies Hospice Signature Requirements
Plus: Get advice from Medicare to discover differences between payment review programs Yo... Read more
CMS Clarifies Hospice Signature Requirements
Plus: Get advice from Medicare to discover differences between payment review programs Yo... Read more
Compliance:
Corporate Integrity Agreements No Longer Apply To Self-Disclosers
Move could save millions for those who cooperate Providers who self-disclose their offens... Read more
Corporate Integrity Agreements No Longer Apply To Self-Disclosers
Move could save millions for those who cooperate Providers who self-disclose their offens... Read more
ICD-9 Coding:
Oncology, Diabetes Top Proposed ICD-9 Codes
New diagnosis codes could be effective Oct. 1, if approved If you've got high hopes that ... Read more
Oncology, Diabetes Top Proposed ICD-9 Codes
New diagnosis codes could be effective Oct. 1, if approved If you've got high hopes that ... Read more
Home Health:
Managed Care Problems Plague HHAs
Slow payment and extra documentation requirements are just a few of the headaches Home he... Read more
Managed Care Problems Plague HHAs
Slow payment and extra documentation requirements are just a few of the headaches Home he... Read more
NPI:
Have Your NPI Stars Aligned? Now's The Time
Key: Check your NPPES record and make the necessary corrections May 23, 2008. The Nationa... Read more
Have Your NPI Stars Aligned? Now's The Time
Key: Check your NPPES record and make the necessary corrections May 23, 2008. The Nationa... Read more
Coding Coach:
Know Which Nerve Conduction Study Code Is Right For You
Take the fear out of modifier 59 using the scenarios our experts reveal Choosing the appr... Read more
Know Which Nerve Conduction Study Code Is Right For You
Take the fear out of modifier 59 using the scenarios our experts reveal Choosing the appr... Read more
Coding Coach:
Cruise To The Bank With NCS Reimbursement
Exceed carrier limits the legitimate way -- here's how When you're coding for nerve condu... Read more
Cruise To The Bank With NCS Reimbursement
Exceed carrier limits the legitimate way -- here's how When you're coding for nerve condu... Read more
Industry Notes:
CMS Adds To List Of 'Never Events'
Plus: Florida radiologist fined $7 million Get ready for nine new "never events," if CMS ... Read more
CMS Adds To List Of 'Never Events'
Plus: Florida radiologist fined $7 million Get ready for nine new "never events," if CMS ... Read more
Compliance:
Don't Let New Provider Requirements Surprise You
Medicare's new enrollment and revalidation process just got trickier That time of year ha... Read more
Don't Let New Provider Requirements Surprise You
Medicare's new enrollment and revalidation process just got trickier That time of year ha... Read more
Code Utilization:
Compare Your Top 10 Billed Codes To CMS Statistics
Medicare released its latest claims processing data -- and the results may surprise you I... Read more
Compare Your Top 10 Billed Codes To CMS Statistics
Medicare released its latest claims processing data -- and the results may surprise you I... Read more
Part B Revenue Booster:
Time To Brush Up On ASC Coding Rules
As CMS issues its quarterly payment rates, take 5 tips to nail the rules down True or fal... Read more
Time To Brush Up On ASC Coding Rules
As CMS issues its quarterly payment rates, take 5 tips to nail the rules down True or fal... Read more
Long-Term Care:
Nursing Facilities Targeted For Help With High-Risk Pressure Ulcer Quality Measures
This is a list you could end up on no matter what -- here's what to do now The Centers fo... Read more
Nursing Facilities Targeted For Help With High-Risk Pressure Ulcer Quality Measures
This is a list you could end up on no matter what -- here's what to do now The Centers fo... Read more
Home Care:
Competitive Bidding Program Reductions 'Unsustainable'
Medicare funding reductions may eliminate key jobs when demands for quality Leaders in th... Read more
Competitive Bidding Program Reductions 'Unsustainable'
Medicare funding reductions may eliminate key jobs when demands for quality Leaders in th... Read more
Coding Coach:
Watch For Life-Threatening Conditions Before Reporting 99291-99292
Hone your critical care coding skills now and avoid denials later Your physician document... Read more
Watch For Life-Threatening Conditions Before Reporting 99291-99292
Hone your critical care coding skills now and avoid denials later Your physician document... Read more
Industry Notes:
Senate Could Vote On 18-Month Pay Increase By Next Month
Plus: New HCPCS modifier debuts in July Most physicians don't want to wait until June 30 ... Read more
Senate Could Vote On 18-Month Pay Increase By Next Month
Plus: New HCPCS modifier debuts in July Most physicians don't want to wait until June 30 ... Read more
Reader Question:
Track Botulinum Wastage For Accurate Coding
Splitting vials? Bill the exact units given each subject Question: We often perform botul... Read more
Track Botulinum Wastage For Accurate Coding
Splitting vials? Bill the exact units given each subject Question: We often perform botul... Read more
Competitive Bidding:
Round One Bidding Notices Rock DME Industry
Outraged trade groups plan legal action Suppliers nationwide are catching a glimpse of th... Read more
Round One Bidding Notices Rock DME Industry
Outraged trade groups plan legal action Suppliers nationwide are catching a glimpse of th... Read more
Hospice:
Review Could Prove Costly For Some Respite Care Providers
19 percent of these claims didn't meet the 5-day rule, OIG finds If you provide respite c... Read more
Review Could Prove Costly For Some Respite Care Providers
19 percent of these claims didn't meet the 5-day rule, OIG finds If you provide respite c... Read more
Patients' Rights:
NPSF Proposes To Strengthen Provider-Patient Collaboration
Compact to provide patient-friendly care and respect for patients' rights The National Pa... Read more
NPSF Proposes To Strengthen Provider-Patient Collaboration
Compact to provide patient-friendly care and respect for patients' rights The National Pa... Read more
Part B Mythbuster:
Dismantle This Common Wound Repair Myth
Know what 12001-13160 includes to get on the road to correct coding Myth: Wound repair co... Read more
Dismantle This Common Wound Repair Myth
Know what 12001-13160 includes to get on the road to correct coding Myth: Wound repair co... Read more
Legislation:
Mental Health Bill May Restrict Access To Best Hospitals
House and Senate conferees looking to ensure passage of mental health parity act Medicare... Read more
Mental Health Bill May Restrict Access To Best Hospitals
House and Senate conferees looking to ensure passage of mental health parity act Medicare... Read more
Coding Coach:
Details Make 'Transfer Of Care' Black And White
Put consultation requests to this 2-prong test You've been on the fence for two years now... Read more
Details Make 'Transfer Of Care' Black And White
Put consultation requests to this 2-prong test You've been on the fence for two years now... Read more
Reimbursement:
MedPAC Mulls Single Payment For Doctors, Hospitals
Big changes could be in store for hospital, physician reimbursement At its most recent op... Read more
MedPAC Mulls Single Payment For Doctors, Hospitals
Big changes could be in store for hospital, physician reimbursement At its most recent op... Read more
Industry Notes:
Dr. Smith Goes To Washington ... And So Do Hundreds Of Others
Plus: 'Hospital Compare' database offers quality comparison The AMA's National Advocacy C... Read more
Dr. Smith Goes To Washington ... And So Do Hundreds Of Others
Plus: 'Hospital Compare' database offers quality comparison The AMA's National Advocacy C... Read more
Compliance:
Avoid Relationships That Suggest Manufacturer Incentives
CMS cracks down on device-makers relationships with docs If your physician is on the payr... Read more
Avoid Relationships That Suggest Manufacturer Incentives
CMS cracks down on device-makers relationships with docs If your physician is on the payr... Read more
Revenue Booster:
CMS Allows Expanded Payment For At-Home INR Tests
Patients using warfarin for chronic atrial fibrillation or venous thromboembolism are cov... Read more
CMS Allows Expanded Payment For At-Home INR Tests
Patients using warfarin for chronic atrial fibrillation or venous thromboembolism are cov... Read more
Part B Success Story:
Different Specialists May Warrant 2 Same-Day Consults
One practice reports success after deliberations with a Medicare payer If you've ever bat... Read more
Different Specialists May Warrant 2 Same-Day Consults
One practice reports success after deliberations with a Medicare payer If you've ever bat... Read more
Medicare:
Report: Medicare Program Risks Going Broke
With Part A funding about to bottom out, Part B could be at risk as well The recent widel... Read more
Report: Medicare Program Risks Going Broke
With Part A funding about to bottom out, Part B could be at risk as well The recent widel... Read more
Coding Coach:
Get More Money With 2 PQRI Details
Are you in? Medicare's second reporting period began in January Thanks to PQRI's renewal,... Read more
Get More Money With 2 PQRI Details
Are you in? Medicare's second reporting period began in January Thanks to PQRI's renewal,... Read more
Coding Coach:
Append Modifiers When Measure Isn't Met
Surprise: 'No action' still counts toward PQRI total To successfully participate in the P... Read more
Append Modifiers When Measure Isn't Met
Surprise: 'No action' still counts toward PQRI total To successfully participate in the P... Read more
Industry Notes:
CMS Wants Your Input
Plus: CLIA-waived status list updated CMS is eager to get feedback from physicians, provi... Read more
CMS Wants Your Input
Plus: CLIA-waived status list updated CMS is eager to get feedback from physicians, provi... Read more
Reader Question:
Document Time Spent On Counseling
Make sure to note the ratio of total visit time to counseling time Question: One of our i... Read more
Document Time Spent On Counseling
Make sure to note the ratio of total visit time to counseling time Question: One of our i... Read more
Payment:
House, Senate Want To Make Sure You Don't Face Pay Cuts
As the vote nears the floor, physicians are cautiously optimistic If you've been wishing ... Read more
House, Senate Want To Make Sure You Don't Face Pay Cuts
As the vote nears the floor, physicians are cautiously optimistic If you've been wishing ... Read more
Concierge Care:
State Fines MD Who Wasn't Up-Front About Certification
Massachusetts concierge physician gets burned for medical record maintenance If you're ru... Read more
State Fines MD Who Wasn't Up-Front About Certification
Massachusetts concierge physician gets burned for medical record maintenance If you're ru... Read more
Revenue Booster:
Nail Down Postsurgical Modifier Choice
Once you realize the differences between modifiers 58 and 78, selection can be a breeze I... Read more
Nail Down Postsurgical Modifier Choice
Once you realize the differences between modifiers 58 and 78, selection can be a breeze I... Read more
Medicaid:
Physicians Reaping Benefits Of Privately Insured Patients
The Medicaid safety net is unraveling, says a new study According to a recent study, the ... Read more
Physicians Reaping Benefits Of Privately Insured Patients
The Medicaid safety net is unraveling, says a new study According to a recent study, the ... Read more
Legislation:
Mandatory Price Disclosure Bill Might Increase Costs
Medical technology bill is unlikely to benefit patients or hospitals, experts say Pending... Read more
Mandatory Price Disclosure Bill Might Increase Costs
Medical technology bill is unlikely to benefit patients or hospitals, experts say Pending... Read more
Coding Coach:
Review Documentation Hazards For Stress Test Claims
Tip: Make sure the physician documents direct supervision You may think you've got stress... Read more
Review Documentation Hazards For Stress Test Claims
Tip: Make sure the physician documents direct supervision You may think you've got stress... Read more
Long-Term Care:
CMS Proposes Payment Boost For LTCHs
Effective date change also proposed The Centers for Medicare and Medicaid Services (CMS) ... Read more
CMS Proposes Payment Boost For LTCHs
Effective date change also proposed The Centers for Medicare and Medicaid Services (CMS) ... Read more
Industry Notes:
CMS Opens Door To CPAP Payment
Plus: Look for revised RARCs and CARCs If you were worried about narrow diagnosis issues ... Read more
CMS Opens Door To CPAP Payment
Plus: Look for revised RARCs and CARCs If you were worried about narrow diagnosis issues ... Read more
CCI Edits:
Say Goodbye To DEXA Edits
New CCI additions may disappoint some practices For once, you've got some good news from ... Read more
Say Goodbye To DEXA Edits
New CCI additions may disappoint some practices For once, you've got some good news from ... Read more
Part B Revenue Booster:
CMS' Updated, Revised ABN Now Effective
The new ABN may cut the need for an NEMB If you ever made alphabet soup out of the ABN ve... Read more
CMS' Updated, Revised ABN Now Effective
The new ABN may cut the need for an NEMB If you ever made alphabet soup out of the ABN ve... Read more
Part B Revenue Booster:
Get To Know These Common Reasons For ABN Use
5 examples show you when the new ABN suits your needs The new advance beneficiary notice ... Read more
Get To Know These Common Reasons For ABN Use
5 examples show you when the new ABN suits your needs The new advance beneficiary notice ... Read more
Spending:
Health Care Spending Can Rise Up To $4.3 Trillion By 2017
Health care likely to consume an expanding share of the U.S. economy over the next decade... Read more
Health Care Spending Can Rise Up To $4.3 Trillion By 2017
Health care likely to consume an expanding share of the U.S. economy over the next decade... Read more
Coding Coach:
Don't Roll The Dice With Botox Reimbursements
Surefire strategies take luck out of the Botulinum toxin equation You face a lot of bumps... Read more
Don't Roll The Dice With Botox Reimbursements
Surefire strategies take luck out of the Botulinum toxin equation You face a lot of bumps... Read more
Reimbursement:
Bush Encounters Strong Opposition To Proposed Cuts
73 percent to support the candidate who does not implement the cuts The Bush administrati... Read more
Bush Encounters Strong Opposition To Proposed Cuts
73 percent to support the candidate who does not implement the cuts The Bush administrati... Read more
Industry Notes:
Apply For Accreditation To Collect For Imaging
Plus: California hospitals overpaid by $3.5 million If you bill United Healthcare (UHC) o... Read more
Apply For Accreditation To Collect For Imaging
Plus: California hospitals overpaid by $3.5 million If you bill United Healthcare (UHC) o... Read more
Reader Question:
Primary Surgeon Should Keep Global In Mind
Initial consultation, diagnostic tests are also fair game Question: If a neurosurgeon cal... Read more
Primary Surgeon Should Keep Global In Mind
Initial consultation, diagnostic tests are also fair game Question: If a neurosurgeon cal... Read more
Part B Payment:
Raise Physician Payment In 2009, Advises MedPAC
But where there are hikes, there are also drops The Medicare Payment Advisory Commission ... Read more
Raise Physician Payment In 2009, Advises MedPAC
But where there are hikes, there are also drops The Medicare Payment Advisory Commission ... Read more
Reimbursement:
Report Slams Medicare's Competitive Bidding 'Scheme'
Suppliers call for suspension of program Suppliers of durable medical equipment are stepp... Read more
Report Slams Medicare's Competitive Bidding 'Scheme'
Suppliers call for suspension of program Suppliers of durable medical equipment are stepp... Read more
Coding Coach:
3 Can't-Miss Radiology Coding Lessons
Will Medicare be asking you to return part of the $59 million overpaid to radiologists? C... Read more
3 Can't-Miss Radiology Coding Lessons
Will Medicare be asking you to return part of the $59 million overpaid to radiologists? C... Read more
Fraud & Abuse:
CMS Limits Home Health Aide Visits In Fraud-Prone Area
System will automatically deny claims with more than 3 aide visits per week Legitimate ho... Read more
CMS Limits Home Health Aide Visits In Fraud-Prone Area
System will automatically deny claims with more than 3 aide visits per week Legitimate ho... Read more
RACs:
Recovery Audit Contractors Collect $371.5 Million
Described as 'bounty hunters,' RACs are still frowned upon by many If a recovery audit co... Read more
Recovery Audit Contractors Collect $371.5 Million
Described as 'bounty hunters,' RACs are still frowned upon by many If a recovery audit co... Read more
PQRI:
Master Modifiers To Avoid Losing Out On Reimbursement
Make the 2008 PQRI work for you with these expert insights The Physician Quality Reportin... Read more
Master Modifiers To Avoid Losing Out On Reimbursement
Make the 2008 PQRI work for you with these expert insights The Physician Quality Reportin... Read more
Industry Notes:
AMA Reacts To Medicare Payment Cut Projections
Plus: OIG targets routine foot care Your Medicare payment woes may not end in July, accor... Read more
AMA Reacts To Medicare Payment Cut Projections
Plus: OIG targets routine foot care Your Medicare payment woes may not end in July, accor... Read more
Legislation:
Trigger Bill Could Be First In String Of Proposals
Lawmakers officially introduce a bill to curb Medicare spending The proposals to "fix" Me... Read more
Trigger Bill Could Be First In String Of Proposals
Lawmakers officially introduce a bill to curb Medicare spending The proposals to "fix" Me... Read more
Revenue Booster:
Check With Your Carrier For Assistant Surgeon Billing
Warning: Assistant surgeon rules differ between carriers, and change in teaching hospital... Read more
Check With Your Carrier For Assistant Surgeon Billing
Warning: Assistant surgeon rules differ between carriers, and change in teaching hospital... Read more
E/M Basics:
Observation Codes Differ Greatly, CMS Reminds Practices
MLN Matters provides guidance on observation and hospital care coding Think fast: Do you ... Read more
Observation Codes Differ Greatly, CMS Reminds Practices
MLN Matters provides guidance on observation and hospital care coding Think fast: Do you ... Read more
HIPAA:
Defend Patient's PHI With Shredders
Put your shredder where it will be used most If an identity thief nabs some of a patient'... Read more
Defend Patient's PHI With Shredders
Put your shredder where it will be used most If an identity thief nabs some of a patient'... Read more
Coding Coach:
5 Tips To Keep Your PEG Coding From Going Down The Tubes
Hint:G-tube procedures now include fluoroscopic guidance, when used Recent AMA revisions ... Read more
5 Tips To Keep Your PEG Coding From Going Down The Tubes
Hint:G-tube procedures now include fluoroscopic guidance, when used Recent AMA revisions ... Read more
Benefits:
U.S. Increases Services For Weapons Industry Workers
Resource center staff to provide claims assistance The U.S. Department of Labor is taking... Read more
U.S. Increases Services For Weapons Industry Workers
Resource center staff to provide claims assistance The U.S. Department of Labor is taking... Read more
Industry Notes:
Medicare Remains Among OIG's Biggest Challenges
Plus: MA plans costing more than expected Earlier this week, the HHS Office of Inspector ... Read more
Medicare Remains Among OIG's Biggest Challenges
Plus: MA plans costing more than expected Earlier this week, the HHS Office of Inspector ... Read more
Reader Question:
Don't Count On Patient For WTM Data
'Welcome to Medicare' exam is a once-in-a-lifetime benefit Question: Recently, we've been... Read more
Don't Count On Patient For WTM Data
'Welcome to Medicare' exam is a once-in-a-lifetime benefit Question: Recently, we've been... Read more
2009 Budget:
Bush's Proposal Makes Beneficiaries Pay More
Proposed budget cuts ASC, outpatient hospital and hospice pay When President Bush propose... Read more
Bush's Proposal Makes Beneficiaries Pay More
Proposed budget cuts ASC, outpatient hospital and hospice pay When President Bush propose... Read more
Compliance:
OIG Report Shows Stark Laws Haven't Curbed Some Habits
Kickbacks still stir up the Office of Inspector General's interest Despite the recent buz... Read more
OIG Report Shows Stark Laws Haven't Curbed Some Habits
Kickbacks still stir up the Office of Inspector General's interest Despite the recent buz... Read more
Compliance:
Peruse This Breakdown Of The OIG's Report
No entities were spared in 2006 If you want to know who got caught in the OIG's net in 20... Read more
Peruse This Breakdown Of The OIG's Report
No entities were spared in 2006 If you want to know who got caught in the OIG's net in 20... Read more
Billing:
New Software May Answer Secondary Payer Woes
Consider downloading additional software from your carrier or clearinghouse if necessary ... Read more
New Software May Answer Secondary Payer Woes
Consider downloading additional software from your carrier or clearinghouse if necessary ... Read more
Coding Coach:
Ask These 4 Questions Before Choosing Debridement Code
FAQ addresses coding conventions for wound care Patients who present to your practice for... Read more
Ask These 4 Questions Before Choosing Debridement Code
FAQ addresses coding conventions for wound care Patients who present to your practice for... Read more
Appeals:
Update Your Appeal Flowcharts
CMS changes threshold amounts -- here's the new chart You have one more change to incorpo... Read more
Update Your Appeal Flowcharts
CMS changes threshold amounts -- here's the new chart You have one more change to incorpo... Read more
Health Care:
PGP Demonstration Aims To Improve Health Care Quality
Pilot project encourages physicians to invest more in technology, quality improvement The... Read more
PGP Demonstration Aims To Improve Health Care Quality
Pilot project encourages physicians to invest more in technology, quality improvement The... Read more
Industry Notes:
Some Practices Still Aren't Ready For NPI
Plus: Empire clarifies Zostavax coverage Despite CMS' frequent reminders, many Medicare-p... Read more
Some Practices Still Aren't Ready For NPI
Plus: Empire clarifies Zostavax coverage Despite CMS' frequent reminders, many Medicare-p... Read more
Error Reporting:
HHS Puts Medical Error Guidance In Writing
HIPAA confidentiality violations will cost $20,000 apiece under proposed rule If the U.S.... Read more
HHS Puts Medical Error Guidance In Writing
HIPAA confidentiality violations will cost $20,000 apiece under proposed rule If the U.S.... Read more
Compliance:
Wondering Why MUEs Matter?Recent Audits Show You
Watch those big-ticket claims or the OIG will watch for you If big-ticket claims ar... Read more
Wondering Why MUEs Matter?Recent Audits Show You
Watch those big-ticket claims or the OIG will watch for you If big-ticket claims ar... Read more
Reimbursement:
Expect Detours On Road To NPI-Only Claims
Tip: Take stock of enrollment status now Gear up for a rough transition to NPI-only claim... Read more
Expect Detours On Road To NPI-Only Claims
Tip: Take stock of enrollment status now Gear up for a rough transition to NPI-only claim... Read more
Billing:
Don't Let These NPI Traps Kill Your Cash Flow
No news might turn into really bad news -- soon Sound a loud warning if your billing offi... Read more
Don't Let These NPI Traps Kill Your Cash Flow
No news might turn into really bad news -- soon Sound a loud warning if your billing offi... Read more
Coding Coach:
Make Diagnosis Codes Support Preventive Med Claim
2 scenarios pinpoint the perfect counseling code You could be missing out if you don't re... Read more
Make Diagnosis Codes Support Preventive Med Claim
2 scenarios pinpoint the perfect counseling code You could be missing out if you don't re... Read more
Legislation:
Congress Drops Surety Bond Bomb
Senator pushes for ten-fold increase in bond amount A new Senate bill could be the beginn... Read more
Congress Drops Surety Bond Bomb
Senator pushes for ten-fold increase in bond amount A new Senate bill could be the beginn... Read more
Industry Notes:
CMS Offers Physician Self-Referral Guidance
Plus: Florida docs meet on Medicare reform If you have more Stark questions than answers,... Read more
CMS Offers Physician Self-Referral Guidance
Plus: Florida docs meet on Medicare reform If you have more Stark questions than answers,... Read more
Reader Question:
Know The Ropes Of Medicare Opt-Outs
Take a look at the potential rewards -- and risks Question: In anticipation of the July 1... Read more
Know The Ropes Of Medicare Opt-Outs
Take a look at the potential rewards -- and risks Question: In anticipation of the July 1... Read more
REIMBURSEMENT:
House Dems Pledge To Fight Proposed Budget Bill
President's budget would slash future Medicare fundsIf President Bush has his way, he'll g... Read more
House Dems Pledge To Fight Proposed Budget Bill
President's budget would slash future Medicare fundsIf President Bush has his way, he'll g... Read more
BILLING:
5 Steps Reveal Your Cash Flow Secrets
Chart A/R and other variables to avoid leaving money in Medicare's handsIf your billing of... Read more
5 Steps Reveal Your Cash Flow Secrets
Chart A/R and other variables to avoid leaving money in Medicare's handsIf your billing of... Read more
LEGISLATION:
States Move On Implementing Health Reform Laws
Major state coverage expansions depend on federal financing, study statesA recent study ex... Read more
States Move On Implementing Health Reform Laws
Major state coverage expansions depend on federal financing, study statesA recent study ex... Read more
ICD-9 CODING:
3 Steps Keep Your Diabetic Neuropathy Coding Straight
Solve the 337.1-vs.-357.2 puzzle with this easy-to-reference guideYou're going to have to ... Read more
3 Steps Keep Your Diabetic Neuropathy Coding Straight
Solve the 337.1-vs.-357.2 puzzle with this easy-to-reference guideYou're going to have to ... Read more
PHARMACEUTICALS:
Consumer Group Demands Simple Error Reporting
TV ads must provide info on reporting drug problems, group insistsA leading consumer organ... Read more
Consumer Group Demands Simple Error Reporting
TV ads must provide info on reporting drug problems, group insistsA leading consumer organ... Read more
LONG-TERM CARE:
Feds Launch Long-Term Care Planning Program
More options, including in-home care, available to seniors who plan aheadOhio and Pennsylv... Read more
Feds Launch Long-Term Care Planning Program
More options, including in-home care, available to seniors who plan aheadOhio and Pennsylv... Read more
LONG-TERM CARE:
OIG Wants Feedback On Nursing Facilities CPG
Let them know what you think by Feb. 25According to the Jan. 24, 2008, Federal Register, t... Read more
OIG Wants Feedback On Nursing Facilities CPG
Let them know what you think by Feb. 25According to the Jan. 24, 2008, Federal Register, t... Read more
INDUSTRY NOTES:
CMS Proposes Artificial Heart Device Coverage
Plus: MLN Matters launches new Web portalOn Feb. 1, CMS proposed coverage "with evidence d... Read more
CMS Proposes Artificial Heart Device Coverage
Plus: MLN Matters launches new Web portalOn Feb. 1, CMS proposed coverage "with evidence d... Read more
Imaging:
Chiropractor-Requested X-Rays No Longer Valid
Medicare's 'chiropractor exception' expired earlier this month Medicare has made an age-o... Read more
Chiropractor-Requested X-Rays No Longer Valid
Medicare's 'chiropractor exception' expired earlier this month Medicare has made an age-o... Read more
HCPCS:
Quarterly Update Announces Revisions, Corrections
CMS changes its mind, reinstating Albuterol HCPCS codes this April In a move sure to surp... Read more
Quarterly Update Announces Revisions, Corrections
CMS changes its mind, reinstating Albuterol HCPCS codes this April In a move sure to surp... Read more
Colonoscopies:
Colonoscopy Procedure Code May Change, But The Dx Won't
Once a screening, always a screening, CMS says The Centers for Medicare & Medicaid Se... Read more
Colonoscopy Procedure Code May Change, But The Dx Won't
Once a screening, always a screening, CMS says The Centers for Medicare & Medicaid Se... Read more
PPS:
Prospective Payment System Cash Finally Begins To Flow
But how long will it take to catch up? After nearly three weeks under the revised prospec... Read more
Prospective Payment System Cash Finally Begins To Flow
But how long will it take to catch up? After nearly three weeks under the revised prospec... Read more
Compliance:
Get To Know Therapy Cap Amounts
Prepare for $1,810 limit starting July Congress placed a moratorium on Medicare's 2008 th... Read more
Get To Know Therapy Cap Amounts
Prepare for $1,810 limit starting July Congress placed a moratorium on Medicare's 2008 th... Read more
Coding Coach:
Follow These 5 Rules To Modifier 22 Claim Success
You decide which services warrant the effort associated with modifier 22 Catch 22: If you... Read more
Follow These 5 Rules To Modifier 22 Claim Success
You decide which services warrant the effort associated with modifier 22 Catch 22: If you... Read more
Success Story:
Don't Write Off Denials If You Know You're Right
National policy review pays off for one practice In a story in Medicare Compliance & ... Read more
Don't Write Off Denials If You Know You're Right
National policy review pays off for one practice In a story in Medicare Compliance & ... Read more
Reader Question:
You Don't Need A Modifier For Incident-To Claims
For accurate NPP claims, keep an eye on the supervision rules Question: We recently hired... Read more
You Don't Need A Modifier For Incident-To Claims
For accurate NPP claims, keep an eye on the supervision rules Question: We recently hired... Read more
DME:
Expect Round 2 Details From CMS This Spring
Seek accreditation now, feds coach The starting bell has sounded for the next round of co... Read more
Expect Round 2 Details From CMS This Spring
Seek accreditation now, feds coach The starting bell has sounded for the next round of co... Read more
Reimbursement:
Keep Physician Signatures -- And Claims -- On Track
Faxes and electronic signatures are OK (again) for hospice certifications, but stamped si... Read more
Keep Physician Signatures -- And Claims -- On Track
Faxes and electronic signatures are OK (again) for hospice certifications, but stamped si... Read more
Consults:
Stay Intent On Documentation In Lieu Of Consult Clarification
Ensure you know the 5 consultation keys -- we’ll tell you what they are Rumors h... Read more
Stay Intent On Documentation In Lieu Of Consult Clarification
Ensure you know the 5 consultation keys -- we’ll tell you what they are Rumors h... Read more
Medicaid:
CMS Pushes Self-Directed Care
Medicaid benes would hire and manage their own assistants under proposed rule Businesses ... Read more
CMS Pushes Self-Directed Care
Medicaid benes would hire and manage their own assistants under proposed rule Businesses ... Read more
Spending:
Health Expenditure Jumps To $2.1 Trillion
High growth in drugs and Medicare spending blamed In 2006, the new Medicare prescription ... Read more
Health Expenditure Jumps To $2.1 Trillion
High growth in drugs and Medicare spending blamed In 2006, the new Medicare prescription ... Read more
Coding Coach:
Brush Up On Pain Management Procedures And Codes Before OIG Comes Calling
Know what specialists do to win the coding battle As pain management continues to grow, y... Read more
Brush Up On Pain Management Procedures And Codes Before OIG Comes Calling
Know what specialists do to win the coding battle As pain management continues to grow, y... Read more
PATIENT EDUCATION:
Clear, Correct Answers To Patients' Medicare Questions
Conquer confusion about assignment, copayments and ABNs Let's face it: Medicare is so com... Read more
Clear, Correct Answers To Patients' Medicare Questions
Conquer confusion about assignment, copayments and ABNs Let's face it: Medicare is so com... Read more
SCHIP:
SCHIP Plan Causes Stir In Child Health Care
CMS curbs Medicaid extension to children above 250 percent of poverty line The Centers fo... Read more
SCHIP Plan Causes Stir In Child Health Care
CMS curbs Medicaid extension to children above 250 percent of poverty line The Centers fo... Read more
Part D:
Part D Overhaul Focuses On Value, Comprehensive Coverage
Price fixation may become the norm Health policy researchers Ruth Lopert, BMed, MMedSc, a... Read more
Part D Overhaul Focuses On Value, Comprehensive Coverage
Price fixation may become the norm Health policy researchers Ruth Lopert, BMed, MMedSc, a... Read more
HIPAA:
Keep Privacy Practices From Going Out Of Sight, Out Of Mind
The government has convicted HIPAA violators -- make sure you're not at risk HIPAA compli... Read more
Keep Privacy Practices From Going Out Of Sight, Out Of Mind
The government has convicted HIPAA violators -- make sure you're not at risk HIPAA compli... Read more
Mental Health:
States Thinking 'Out Of The Box' For Youth Programs
A number of states have come up with novel and successful Medicaid approaches to provide m... Read more
States Thinking 'Out Of The Box' For Youth Programs
A number of states have come up with novel and successful Medicaid approaches to provide m... Read more
Reimbursement:
Forget G Code For Cerumen Removal And Forget Payment
One practice challenged Medicare and won for its G0268 claims If you've got one New Year'... Read more
Forget G Code For Cerumen Removal And Forget Payment
One practice challenged Medicare and won for its G0268 claims If you've got one New Year'... Read more
Documentation:
Make Sure Doc Signs Note Instead Of Rubber-Stamping
Chart auditors may see -- but not agree with -- 'seen and agreed' stamp Rubber stamps can... Read more
Make Sure Doc Signs Note Instead Of Rubber-Stamping
Chart auditors may see -- but not agree with -- 'seen and agreed' stamp Rubber stamps can... Read more
Mythbuster:
Time To Ditch Mid-Year Chemo Replacement Codes
Reporting Q4087 for IVIG? Not anymore Myth: You should report the appropriate Q code (suc... Read more
Time To Ditch Mid-Year Chemo Replacement Codes
Reporting Q4087 for IVIG? Not anymore Myth: You should report the appropriate Q code (suc... Read more
Industry Notes:
MedPAC Recommends Deep Freeze For SNF, Home Health Rates
Plus: Despite computer glitch, you don't need to resubmit NGS claims The Medicare Payment... Read more
MedPAC Recommends Deep Freeze For SNF, Home Health Rates
Plus: Despite computer glitch, you don't need to resubmit NGS claims The Medicare Payment... Read more
Imaging:
CMS Grants Anti-Markup Provision Reprieve Until 2009
Delay does not apply to some pathology services One of Medicare's most confusing new rule... Read more
CMS Grants Anti-Markup Provision Reprieve Until 2009
Delay does not apply to some pathology services One of Medicare's most confusing new rule... Read more
ASCs:
It's OK To Collect From Medicare For Brachytherapy
New Medicare clarification offers good news for ambulatory surgery centers Just before 20... Read more
It's OK To Collect From Medicare For Brachytherapy
New Medicare clarification offers good news for ambulatory surgery centers Just before 20... Read more
CPT 2008:
New Cardiac MRI, Ablation Codes Streamline Cardio Practices
Master new cardiology codes and say goodbye to payment woes By now, you're quite aware of... Read more
New Cardiac MRI, Ablation Codes Streamline Cardio Practices
Master new cardiology codes and say goodbye to payment woes By now, you're quite aware of... Read more
Stark Law:
Sharpen Your Self-Referral Law Knowledge
Expert tips help providers navigate part III of the Stark saga If anything in the heal... Read more
Sharpen Your Self-Referral Law Knowledge
Expert tips help providers navigate part III of the Stark saga If anything in the heal... Read more
NPI:
Verify Legacy Numbers To Speed Payment
You need a perfect match on your claims You may be seeing claims rejections if you're not... Read more
Verify Legacy Numbers To Speed Payment
You need a perfect match on your claims You may be seeing claims rejections if you're not... Read more
Compliance:
Forgetting Signature Can Cost You Thousands
Recent OIG audit shows that one therapist's mistakes will cost him over $280,000 You've m... Read more
Forgetting Signature Can Cost You Thousands
Recent OIG audit shows that one therapist's mistakes will cost him over $280,000 You've m... Read more
HIPAA:
Think A PHI Release Authorization Is Forever? Think Again
Here's how to make sure your authorization hasn't expired One year ago, your patient sign... Read more
Think A PHI Release Authorization Is Forever? Think Again
Here's how to make sure your authorization hasn't expired One year ago, your patient sign... Read more
Industry Notes:
Hospices Should Shore Up Claims Data
Plus: Competitive bidding keeps growing Starting in July, CMS requires your hospice claim... Read more
Hospices Should Shore Up Claims Data
Plus: Competitive bidding keeps growing Starting in July, CMS requires your hospice claim... Read more
DME:
New Deadline Disappoints Accreditation Advocates
Ante up -- or lose Medicare payments Suppliers of durable medical equipment, prosthetics,... Read more
New Deadline Disappoints Accreditation Advocates
Ante up -- or lose Medicare payments Suppliers of durable medical equipment, prosthetics,... Read more
Regulations:
Feds To Suppliers: We Won't Back Down
Denial won't protect your supplier number Low-volume suppliers of home medical equipment ... Read more
Feds To Suppliers: We Won't Back Down
Denial won't protect your supplier number Low-volume suppliers of home medical equipment ... Read more
Part B Mythbuster:
Follow 3 Tips For Your ED Coding Makeover
The emergency department is an outpatient setting, not inpatient Myth: Only a certified e... Read more
Follow 3 Tips For Your ED Coding Makeover
The emergency department is an outpatient setting, not inpatient Myth: Only a certified e... Read more
Minimum Data Set:
MDS 3.0 Is On Its Way, CMS Says -- Here's What To Expect
Agency provides 'high level' view of what's new The countdown for MDS 3.0 implementation ... Read more
MDS 3.0 Is On Its Way, CMS Says -- Here's What To Expect
Agency provides 'high level' view of what's new The countdown for MDS 3.0 implementation ... Read more
Long-Term Care:
Poor-Performing Nursing Homes Now In Medicare's Crosshairs
National list to provide public with choices, agency says Poor-performing nursing homes w... Read more
Poor-Performing Nursing Homes Now In Medicare's Crosshairs
National list to provide public with choices, agency says Poor-performing nursing homes w... Read more
Coding Coach:
Cure Colonoscopy Denials With CMS' Advice
You may be surprised by Medicare's guidance on diagnosis codes If you're confused about w... Read more
Cure Colonoscopy Denials With CMS' Advice
You may be surprised by Medicare's guidance on diagnosis codes If you're confused about w... Read more
Hospice:
Cost Of Hospice Care On Federal Radar Screen -- Again
Care provided in nursing homes costs Medicare more, OIG finds The cost of hospice care is... Read more
Cost Of Hospice Care On Federal Radar Screen -- Again
Care provided in nursing homes costs Medicare more, OIG finds The cost of hospice care is... Read more
Industry Notes:
ALJs' Independence Threatened By Proposed Rule
Plus: Post-acute care demonstration to roll out in 10 cities Seniors could have a much to... Read more
ALJs' Independence Threatened By Proposed Rule
Plus: Post-acute care demonstration to roll out in 10 cities Seniors could have a much to... Read more
Reimbursement:
Docs Get Happy New Year With 0.5 Percent Pay Raise
But the rule only extends until June 30, so you'll still need another fix mid-year If you... Read more
Docs Get Happy New Year With 0.5 Percent Pay Raise
But the rule only extends until June 30, so you'll still need another fix mid-year If you... Read more
CCI 14.0:
Allergy, Urology, Neurology Suffer Scores Of Bundles
CCI strikes new medication therapy management codes If you were delighted about all of th... Read more
Allergy, Urology, Neurology Suffer Scores Of Bundles
CCI strikes new medication therapy management codes If you were delighted about all of th... Read more
CCI 14.0:
Watch For 418 Bundles For Neonatal Hospital Care
Plus:Stop reporting 36000 with injections, surgeries The latest version of the Correct Co... Read more
Watch For 418 Bundles For Neonatal Hospital Care
Plus:Stop reporting 36000 with injections, surgeries The latest version of the Correct Co... Read more
Anesthesia:
Try These Tips To Collect For CVP Placement
If the surgeon bills it first, appeal with your documentation The next time your anesthes... Read more
Try These Tips To Collect For CVP Placement
If the surgeon bills it first, appeal with your documentation The next time your anesthes... Read more
Part B Coding Coach:
Report Co-Management Correctly With Mods 54 And 55
You're in for a world of denials if you miss this coordination tip If your physician is c... Read more
Report Co-Management Correctly With Mods 54 And 55
You're in for a world of denials if you miss this coordination tip If your physician is c... Read more
Optometry:
Look To G, V Codes When Reporting Glaucoma Screens
ABN is a must if the patient is ineligible for Medicare covered test When your optometris... Read more
Look To G, V Codes When Reporting Glaucoma Screens
ABN is a must if the patient is ineligible for Medicare covered test When your optometris... Read more
Industry Notes:
OIG Report Reflects On $43 Billion In Recoveries
Plus: Find out what the NPI Enumerator can -- and can't -- do The HHS Office of Inspector... Read more
OIG Report Reflects On $43 Billion In Recoveries
Plus: Find out what the NPI Enumerator can -- and can't -- do The HHS Office of Inspector... Read more
Reader Question:
Consider Redetermination To Prove Medical Necessity
Tip: Check the LCD list before you appeal Question: We performed a service that we know w... Read more
Consider Redetermination To Prove Medical Necessity
Tip: Check the LCD list before you appeal Question: We performed a service that we know w... Read more