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Medicare Compliance & Reimbursement

Performance:
PAC Settings: Prepare for More Transparency of Your Staffing Ups and Downs
IMPACT Act introduces new quality measures. All eyes will be on your staffing turnover... Read more
Benefits Verification:
Are Those Insurance Details Current? Tips Help You Avoid Costly Billing Errors In Early 2015
Ensure patient coverage changes don’t wreak havoc on your practice’s bottom ... Read more
E/M Errors:
Know the Top Pitfalls of E/M Coding
Ward off common documentation errors to ensure coding success. There are some coding e... Read more
Medicare Approvals:
Note Who Provided the Service Before Billing Audiology Tests
Ensure physician’s order to prevent having to write off claim. Bear in mind that... Read more
Industry Notes:
'No Show' Physician Faces 5 Years in Prison Over $13 Million Scheme
A Brooklyn, NY healthcare clinic was raking in cash over the past several years, despite... Read more
Reader Question:
Ask Payer Preference for Modifier 91 vs. 59
Question: Our lab performed a basic metabolic panel with total calcium, and the phy... Read more
Reader Question:
Know the Rules for Multiple Critical Care Doctors
Question: Recently, our facility admitted an established heart patient with acute r... Read more
Outpatient Outlook:
Tune In to Key Changes Listed in 2015 Medicare Physician Fee Schedule
Chronic care management gains big victory in new, reimbursable CPT code. Get ready for... Read more
Post-Acute Care:
4 Major Perks of a New PAC Patient Assessment Tool
IMPACT Act paves the road for new and improved discharge methods. Change isn’t a... Read more
Audits and Records:
Are You Among the Providers Who Can't Produce Documentation?
Take note of the four-pronged approach used by CERT reviewers. You don’t want to... Read more
Interpreter Services:
Provide Interpreter Services Without Hurting Your Bottom Line
Clear confusion surrounding these services. Providing services to patients who have li... Read more
HIPAA:
Use OCR Guidance to Update Privacy Policies
The Windsor decision has effectively changed the meaning of three key terms. Federal l... Read more
Industry Notes:
CMS: Submit Requested Documentation within 45 Days,or Face Denials
If your payer is performing a pre-payment audit of your claims, the MAC will typically a... Read more
Reader Question:
Avoid 90662 for Patients Under 65
Question: We reported 90662 for a patient’s Fluzone shot and it was denied. T... Read more
Part B Payment:
Halloween Final Fee Schedule Announcement Leaves Some Practices Spooked
If you want to collect for CCM in 2015, you’ll need to have your certified EHR in ... Read more
Home Health Prospective Payment System:
CMS Reduces Home Health Spending by $60 Million
HHAs warn rebasing cuts are killing the home care industry. Home health agencies (HHAs... Read more
Face To Face:
CMS Places Onus of Ensuring Appropriate Documentation On HHAs
F2F here to stay for a while. The face-to-face encounter is necessary to reduce fraud ... Read more
Industry Notes:
CMS Clears Up the Most Common ICD-10 Myths
You’ve heard there won’t be an ICD-10 book that you can keep on your desk be... Read more
Reader Question:
Whom Do You Bill for Record Transfer Fees?
Question: Our practice discharged a patient due to non-payment, and one week later ... Read more
Reader Question:
Decide Which Certification Your Practice/Facility Wants
Question: Our practice wants to hire only certified coders to ensure we are getting... Read more
Legislation:
Gauge the 'IMPACT' of New Post-Acute Care Law
Payment reform one step closer to becoming a reality. Change is in the air for hospita... Read more
Technology:
Think Ahead: Good EHR Could Prevent Big Headaches
Don’t let the new IMPACT Act be more difficult than it has to be. With so man... Read more
Telemedicine:
Major Telehealth Parity Legislation Continues to Percolate in Congress
21st Century Cures initiative may be the path to becoming a law. The Medicare Teleheal... Read more
Compliance:
Stay on the Right Side of Your Next Audit with These 3 Lessons
Hint: Most Medicaid audits don’t result in a physician being hauled off to prison.... Read more
Advance Beneficiary Notices:
Overcome ABN Confusion
Four reality checks put you on the right payment track. If you think that getting a si... Read more
Part B Documentation:
Heed This MAC Tip on Documentation by Ancillary Staff
Warning: Consider nurse’s documentation as only preliminary information. If your... Read more
Industry Notes:
CMS Keeps Part B Deductibles at Same Level, Though Part A Rises
You won’t have a new number to memorize when checking on whether your Part B patie... Read more
Audits:
3 Medical Examples to Boost Your Documentation Prowess
Discover the top diagnoses and procedures where RACs are aiming their sites. Getting b... Read more
Sports Physicals:
Consider These Options for School Physical Reimbursement
Note: Sports physicals don’t necessarily include counseling and anticipatory guida... Read more
Part B Revenue Booster:
Check the Chart to Avoid this $35 Discharge Mistake
Tip: The time spent needn’t be continuous. Hospital discharge coding hinges on h... Read more
Reimbursement:
Welcome New Quick Settlement Option from CMS
Only two groups of hospitals can apply for this option. The Centers for Medicare &... Read more
HHPPS:
Improve Outcomes or Put Your Reimbursement at Risk
The time to make changes is now. Home health agencies’ (HHAs’) payments ar... Read more
Industry Notes:
Wondering Why Your PQRS Payment Is Low? Look at Sequestration
The Centers for Medicare & Medicaid Services (CMS) has finally released the 2013 Phy... Read more
Reader Question:
Forms to Complete? Consider 99080 with an Office Visit
Question: My physician completed forms relating to the Family and Medical Leave Act... Read more
RACs:
Get Up to Speed on New RAC Contracts, Plans for 2014
Learn the difference between ‘complex’ and ‘automated’ reviews. ... Read more
Best Practices:
Audit-Ready Tips From the Horse's Mouth
Communicating with your RAC is key. How can you prepare for complex RAC reviews? The C... Read more
Incentive Programs:
Don't Hesitate to Enroll in the PQRS and EHR Incentive Programs
Heads up: CMS will soon send notification letters to providers who are subject to the 20... Read more
EHRs:
Hurry up: MU Reporting in 2015 Requires CEHRT
Don’t let delay in Stage 3 compliance lull you into complacence. The Centers for... Read more
Compliance:
Distinguish Between Freestanding ED or Urgent Care Before Coding
Not all licensed freestanding EDs are created equal. With state and individual payer g... Read more
Industry Notes:
CMS Explains Difference Between NPI and PTAN
You know just where to list your NPI on your Medicare claims and you have your PTAN hand... Read more
Reader Question:
Do This When Patient Prevents Timely Filing
Question: We have a timely filing concern. Our physician saw a patient who didn&rsq... Read more
Medicare Errors:
Will Your MAC Come Asking For Money Back?
CMS’s new CERT results show that practices made more errors in 2013 than in the pr... Read more
Clinic Billing Spotlight:
Perfect Your Group Enrollment with These Expert Tips
Learn the basics before submitting the CMS-855-B. When you need to enroll in Medicare ... Read more
Reimbursement:
Overlooking These E/M Tips Could Cost Your Practice $5000 Each Year
Ensure that your documentation supports billing 99211. Caution: Before you decide to b... Read more
Home Health Documentation:
Probe For Additional Details to Keep Reimbursement Flowing After Transition
Keep an eye towards more specific diagnosis codes in ICD-10. Your intake department wi... Read more
Industry Notes:
CMS Reveals ICD-10 Testing Dates
As promised, the Centers for Medicare & Medicaid Services (CMS) has finall... Read more
Reader Question:
Consider Pricing for Modifier 78
Question: For a related procedure done during the global period with modifier 78 at... Read more
Reader Question:
Look Back on the Documentation of Initial Visit for Follow-up Claims
Question: A patient saw our physician because of an abscess, and returned for a fol... Read more
Reader Question:
Call for Advice Before Reporting EMS Directed ALS From the ED
Question: Is there a code for live feed in back from an EMS transport team to the e... Read more
Legislation:
Congress Warms Up to Growing Technology in Healthcare
New legislation would greatly expand Medicare coverage of telehealth. Big changes are ... Read more
Consider the Patient Care Potential of Telemedicine
Count your steps toward telehealth. If you haven’t already dived into telehealth... Read more
Stateside:
Know Your State's Coverage Policies for Telemedicine
Don’t let Medicare coverage keep you from using remote technology. In addition t... Read more
ICD-10:
CMS Clarifies Some Rules Surrounding Usage of ICD-10 Codes
Review guidelines on how to code when the diagnosis isn’t definite. Implementati... Read more
Hospital Outpatient Reimbursement:
Hone Your Same-Day Coding Skills to Avoid Denials
Tip: Distinguish different specialties being billed by the same facility/entity with mod... Read more
Industry Notes:
CMS Issues New 'K' Codes
If you simply can’t wait until Jan. 1 to access new codes, the Centers for Medicar... Read more
Reader Question:
Know How RVUs Impact You
Question: I’ve often heard reference to a code’s “RVUs.” I ... Read more
Billing Spotlight:
Find Your Path To Accurate Reimbursement for SNF Patients
Hint: The secret lies in consolidated billing guidelines. Don’t wait until your ... Read more
ICD-10:
Get Ready to Transition in 2015
After Sept. 30, 2015, ICD-9 codes will no longer be accepted. The Centers for Medicare... Read more
Part B Mythbuster:
Can You Collect Coinsurance at the Time of Service?
Take note: Refunds can be very costly. If you’ve been operating under the impres... Read more
Compliance:
New Screening Edits Aim to Catch MUE Dodges
 Bilateral procedures are in CMS’ crosshairs. The Centers for Medicare &... Read more
What Are MUEs?
Although CCI may be very familiar to you, any practice filing a claim with Medicare shou... Read more
Industry Notes:
Medicare Projected to Go Broke in 2030, Trustees' Report Says
Part A is poised to run out of money — but it’s four years later than previo... Read more
Reader Question:
Even Local Relocation Could Impact Insurers
Question: Our practice is going to be moving a few towns over, which means we will ... Read more
Compliance:
Get a Handle on New Requirements of Minimum Health and Safety Standards
Warning: These changes could affect your facility’s current protocols. Facilitie... Read more
Part B Payment:
Watch for Coding Changes in 2015 Physician Fee Schedule
Don’t miss your opportunity to provide input. The Centers for Medicare & Med... Read more
E/M Coding:
Navigate Medical Decision Making Complexity Smoothly
Assign points to each of the three MDM components that your doctor performs to determine... Read more
Documentation:
HHPPS Proposed Rule Could Make Your Life A Little Easier
By 2015, your face-to-face requirement might be a thing of the past. Apart from the Ph... Read more
Home Health Prospective Payment System:
Case Mix Recalibration Could Take A Big Bite Out Of Your Budget
CMS tries to align payments with current utilization data. The Centers for Medicare &a... Read more
Industry Notes:
Patient Safety Wins With Limits For Nurses
A landmark bill, codifying into state law in Massachusetts, was passed by the Senate on ... Read more
2015 Medicare Physician Fee Schedule:
Good News: Expect Bonus for Chronic Care in 2015
Family practitioners, internists, and independent laboratories see a payment boost, whil... Read more
Nursing Facility Coding:
Discern What Care Was Provided and By Whom Before Coding
Tip: Your reimbursement hinges on reporting the POS correctly. If you hope to secure r... Read more
Enforcement News:
Scrutinize Your Policy for Clauses That Bar Coverage for HIPAA Investigation
Plus: Brace for more struggles with regulatory authorities ahead. If you think that yo... Read more
Home Health Reimbursement:
Your Reimbursement Could Hinge on Outcomes Come 2016
Study is a step in the right direction, experts say. The Centers for Medicare & Me... Read more
Hospice Reimbursement:
Seesaw Financial Future for Hospice
Policymakers want more data before moving ahead with pay reform. The proposed payment ... Read more
Industry Notes:
AHA Sues HHS over Appeals Delays
If you’ve been waiting for the government to hear your Administrative Law Judge (A... Read more
Compliance:
Big Brother is Watching for Fraud and Abuse
$9.1 million record recovery by SMP gives you more reason to be wary. Not every person... Read more
Electronic Health Records:
Good News: CMS Rule May Provide Meaningful Use Extension
Adoption of the 2014 Edition Certified EHR Technology (CEHRT) could hold the key to endi... Read more
E/M Coding:
E/M Services Aren't Automatically Billable Every Time You See a Patient
$6.7 billion in financial waste each year causes a massive drain of Medicare resources, ... Read more
Compliance:
Steer Clear Of These 7 Questionable Billing Practices
Keep your practice out of OIG crosshairs for electrodiagnostic tests. An April 2014 re... Read more
Reimbursement:
Cost Report Confusion Hounds Home Care Providers
Get your blue pen handy to avoid rejections.  You shouldn’t be surprised to... Read more
Industry Notes
One Doctor Indicted in $33 Million Medicare Fraud Charges Imagine how different your b... Read more
Compliance:
Try This When Anesthesiologist Doesn't Quite Meet All Criteria
Hint: Final determination of what constitutes medical direction can vary. When your an... Read more
Documentation:
Remember the Rules for Medical Direction
Meet these 7 criteria and you’re on your way to QY or QZ success. Before you can... Read more
Supervision Guidelines:
Maximize Patient Flow And Physician Time With Savvy Supervision
Caution: Denials and lost reimbursement could head your way if you ignore these guidelin... Read more
Penalties:
Expansion of Civil Monetary Penalties On The Horizon
OIG is planning to add to the list of infractions. If keeping track of the laws and re... Read more
Audits:
Watch The Clock For Medicare Facility Observation Patients
Don’t include time a patient spends waiting for transportation after discharge. ... Read more
Industry Notes:
One Physician Causes Biggest HIPAA Settlement in History
If you search your loved one’s name on the internet, the last thing you want to se... Read more
Reader Question:
Place of Service Guides Ultrasound Coding for Epidural Placement
Question: Is it feasible to use ultrasound rather than fluoroscopy for guidance whe... Read more
Reader Question:
File Documentation of E/M According To The Rules
Question: A physician in our group recently started supervising a resident’s ... Read more
Nursing Facility Visits:
Will Documentation of Your Doctor's SNF Visits Stand Up To Close Scrutiny?
Review of nursing facility care claims data leads to astounding findings. You could fi... Read more
Denial Management:
Know Appropriate Use of Modifier 57
Variations in global period definitions spell trouble for you. Use modifier 57 (Decisi... Read more
Modifier 57 Checklist
Use for E/M services only. Use when an E/M service results in a surgery. Make s... Read more
ICD-10:
CMS Keeps Coding Community on Tenterhooks with ICD-10 Questions
Reps say IPPS and implementation of ICD-10 unrelated. You’re not alone if you ha... Read more
Revenue Booster:
Eliminate Confusion On When To Use Modifiers 52 and 53
You needn’t forego payment for incomplete service. When your surgeon stops a pro... Read more
5 Easy Billing Tips for Modifiers 52 and 53
File preparation and clear documentation are the keys to getting these claims paid. ... Read more
Industry Notes:
Watch Out For Aggressive OCR Audits This Fall
Keep your eyes peeled this autumn for a notification and data request from the HHS Offic... Read more
Reader Question:
Learn When Multi-Provider Visit Could Be Shared Service
Question: My physician and a physician’s assistant visited the same patient i... Read more
Reader Question:
Exercise Caution When Reporting E/M Service With AWV Codes
Question: Our FP recently performed an evaluation and management service during an ... Read more
Compliance:
Don't Fall Victim To Heightened OIG Scrutiny
Tip: Be careful about which services you let NPPs perform. You want to bring in additi... Read more
Advance Beneficiary Notices:
Reduce Risk Of Fraud Or Abuse Allegations
Identify services which are routinely excluded by Medicare. If you need to furnish a p... Read more
Cheat Sheet:
Follow This Chart to Ease ABN Concerns
Use this table to pick the right modifier — every time. With four choices and ch... Read more
Face To Face:
Bad Habits Of Physicians Come Back To Bite Home Health Agencies
Missing or insufficient documentation among top flaws. Ever since F2F became mandatory... Read more
These 6 Items Must Appear in Your F2F Documentation
Don’t let missing title, date torpedo your claim. Physicians and home care pr... Read more
Industry Notes:
New ICD-10 Implementation Date Oct. 1, 2015, IPPS Says
Although it was over a month ago that Congress voted to extend the ICD-10 implementation... Read more
Reader Question:
It's Time to Use New Claim Form
Question: I need some help concerning the rules for billing on the new CMS-1500 for... Read more
Reader Question:
Be Wary of Home Health Software that Does Your OASIS Job For You
Question: Our software vendor claims that an upcoming upgrade will allow our agency... Read more
Part B Mythbuster:
Don't Fall Victim to this Critical Care Myth
Location cuts both ways. A recent clarification on critical care services from the Cen... Read more
Reimbursement:
Prevent An Unpleasant Surprise for Parents
What to do if parents balk at copay for non-wellness care. Your practice must provide ... Read more
Billing:
Boost Your Charge Capture
Going electronic holds the key to better coding and improved workflow. Complicated rul... Read more
Part B Mythbuster:
Don't Throw Away Thousands of Dollars
Billing x-ray charges appropriately can make all the difference. Think the x-rays that... Read more
PQRS Update:
Update Billing Software for PQRS Claims
Are you trying to avoid the penalty or earn a bonus? Get ready for two new Medicare re... Read more
Home Health OASIS:
Prioritize OASIS-C1 Preparation Activities To Make Most of the ICD-10 Delay
CMS has yet to announce a new implementation date. Home health agencies should not rel... Read more
Industry Notes:
Hold Off on End-to-End ICD-10 Testing Prep
If you’ve been waiting by the phone to find out if you’ve been selected to p... Read more
Reader Question:
Determine Sick Visit Vs. Camp Physical
Question: We had an asthmatic patient present because she required an Epi-pen to ta... Read more
Reader Question:
Know When to Use UB04 vs. CMS-1500 Form
Question: Under which circumstance can a freestanding ASC use both the UB-04 and CM... Read more
Reader Question:
Stay Away From Rubber Stamps
Question: Our doctor uses dictation because he has arthritis and therefore can&rsqu... Read more
ICD-10 Delay:
ICD-10 Deadline May Be Moving Target -- But Stay Nimble
Tip: Stay ahead in the documentation race. Some providers may be breathing a sigh of r... Read more
Recovery Audit Contractors:
Don't Double Dip with Hospital Visits
Tip: Incorrect coding will invite RAC scrutiny. If your doctor is billing for seeing a... Read more
Reimbursement:
Collect Most Accurate Payments for Your Pediatric Practice
Don’t give away your services. You know that billing issues can lead to lower pa... Read more
Medicare Immunizations:
Know When to Bill for Tetanus Shots
Tip: Prove medical necessity rather than preventive service. If you have been puzzling... Read more
Industry Notes:
New CMS-1500 Requires Letters, Not Numbers, for Dx Pointer
Although CMS’s latest iteration of the CMS-1500 form (version 02/12) doesn’t... Read more
Reader Question:
Encounters vs. Days for Inpatient Visit Coding
Question: A Medicare inpatient was aggressive and needed restraints several times d... Read more
ICD-10 Update:
Physician Pay Fix Bill Brings ICD-10 Surprise
Implementation questions remain unanswered. The Protecting Access to Medicare Act of 2... Read more
Denial Management:
Refresh Documentation Know-How for Total Joint Replacements -- or Risk Claim Denials
Dodge denial code 5J504 (Need for service/item not medically and reasonably necessary). ... Read more
Resources:
Read Widely To Bolster Documentation
One obstacle to foolproof documentation for total joint replacement is the lack of a nat... Read more
RAC Reminder:
Watch Out for New ADRs
Don’t be lulled into complacency by the break in Addition Documentation Requests (... Read more
ICD-10:
Catch CMS Response to ICD-10 Complaints
ICD-10 will help move towards more accountable care. With the ICD-10 transition date h... Read more
ICD-10 Transition:
Ensure You're on the Same Page as Workers' Comp Insurers with ICD-10 Issues
Non-covered entities are not required to make the transition to ICD-10. If you think a... Read more
Industry Notes:
Psychotherapy With E/M? Break Down Time Spent on Each
When CPT® revised the psychotherapy and psychiatry codes last year, many mental heal... Read more
Reimbursement:
Take The Lead On Adult Immunizations
Secure the reimbursement you deserve. With the Affordable Care Act ushering in a new e... Read more
Boost Immunization Rates in 4 Steps
The Centers for Disease Control and Prevention recently outlined the following four stan... Read more
Resources
Quick Reference Information: Medicare Immunization Billing Quick Reference Chart, update... Read more
Compliance:
Are You Up to Speed on Compliance Rules and Regulations?
Don’t rely on a pre-written compliance plan. If you’ve been handling compl... Read more
Cheat Sheet:
Code Correctly For Quick-Pay Claims
** CPT® code 90673 replaced Healthcare Common Procedure Coding System (HCPCS&... Read more
CERT Results:
Are Your Documentation Errors Leaving Money On the Table?
Tip: Upcoding isn’t the only issue, CMS says. The Centers for Medicare & ... Read more
Industry Notes:
Unable to Get Patient History? Follow These Tips
Nearly every physician has been there — you’re trying to get a patient&rsquo... Read more
ICD-10 Readiness:
Don't Miss These Opportunities to Check Your ICD-10 Readiness
CMS is determined to ensure your successful transition to ICD-10. The Centers for Medi... Read more
Home Health Communication:
Avoid Sentinel Events With Effective Communication
Summarize the patient’s situation using an SBAR. You can improve outcomes and de... Read more
Don't Be Hesitant to C.U.S.S.
Sometimes you need a little extra oomph to get your point across. When everything goes... Read more
Part B Coding:
Get Official Guidance on These Tricky Compliance Issues
Tip: Knowing what not to do can make all the difference. Don’t depend on hearsay... Read more
Tool:
SBAR Communication
SBAR Communication Outline ... Read more
Home Health Reimbursement:
Get Claims Reviewed Without Going Through the Appeals Process
Home health agencies have something to cheer about. Good news: You can get some PECOS ... Read more
Industry Notes:
False Billings Lead to Mail Fraud Charge for Texas Physician
You’re aware of the fact that the government could charge you with Medicare fraud ... Read more
Reader Question:
Say Good-Bye to G8553 for E-Prescribing
Question: Is there a new code to show Medicare that we are e-prescribing in 2014? W... Read more
Reader Question:
Know Your Best CCI Modifier Options
Question: Other than modifier 59 (Distinct procedural services), which other modifi... Read more
Compliance:
Know What The OIG Will Be Targeting
Documentation vulnerabilities are under the scanner in the latest Work Plan. The Offic... Read more
Compliance:
Consider These Additional OIG Hotspots For 2014
Although E/M services and place of service codes are used almost every day in Part B pra... Read more
Home Health Compliance:
Documentation, Background Checks On OIG's Hit List For HHAs This Year
Home health agencies bilk Medicare of $1 billion, the OIG says. The HHS Office of the... Read more
ICD-10:
Smooth Out The Path From ICD-9-CM to ICD-10
Let these tips from NGS guide you. Getting ready to submit your claims using the new I... Read more
2014 Billing:
Check Before Billing For Part B Inpatient
Tip: Some services are not inherently outpatient. Part B inpatient billing is not a to... Read more
Industry Notes:
Industry Notes:
Several MACs Open Up ICD-10 Testing Registrations March 3 is less than a month away, s... Read more
Compliance:
Avoid These Missteps That Will Put You In The RAC Spotlight
Beware the new audit issues which will impact your practice the most. Here’s new... Read more
Check These 3 RAC FAQs
Although CMS’s Recovery Audit Contractor (RAC) program has been around for several... Read more
Audits:
Your Facility Could Be On the OIG Hit List
Improper payments totaled over a billion dollars in 2010 and 2011. The recovery audit ... Read more
Reimbursement Updates:
Add 4 New Procedures And Strengthen Your Bottom Line
Medicare won’t allow resubmissions for missing G codes. The Centers for Medicare... Read more
PECOS System:
Take 8 Steps to Avoid PECOS Rejections
PECOS edits are finally switched on. Just when healthcare providers were beginning to ... Read more
Reimbursement:
Use This Checklist to Keep Claims Clean
Boost accuracy and payment and avoid denials with this handy cheat sheet. Has your off... Read more
Industry Notes
Windows XP Won’t Be HIPAA Compliant Starting April 8 You may have heard that Mic... Read more
Part B Payment:
Iron Out Wrinkles To Keep Medicare Payment Collections Smooth
Follow this advice to navigate Part B payment terrain. New payment regulations can ser... Read more
OPPS 2014:
Revise Your Reporting Strategy To Deal With These OPPS Changes in 2014
Here’s an incentive to negotiate more effectively with suppliers to lower costs. ... Read more
SNF Care Planning:
Mind The Compliance Angle of Care Planning
Organize and execute an effective goal statement to achieve measurable outcomes. Compl... Read more
PECOS Edits:
Mitigate Damage When PECOS Edits Hit
Keeping systems ready is essential. The PECOS edits have been turned on despite multip... Read more
PECOS Edits:
Keep Your PECOS Response Plan Ready
Ensure that patients don’t suffer because of noncompliant physicians. Hopefully ... Read more
Home Health Reimbursement:
Check Physician Enrollment In PECOS Before Accepting Referral
Lack of clarity on how the edits will impact RAPs. There is still some measure of conf... Read more
Industry Notes:
OIG Recovered $5.8 Billion in the Second Half of FY 2013
Between conversion factor issues and sequestration, Medicare is cutting back on payments... Read more
Part B Payment:
Keep Your Fingers Crossed For Permanent Fix Of Medicare Payment System
Congress has a great holiday gift for you. On Dec. 19, Congress approved a 0.5 percent... Read more
Reimbursement:
Innovative Approach To Handling Patients With Chronic Issues Proposed
Good news: Sustainable Growth Rate could be on the way out. March will come in like a ... Read more
SNF Reimbursement:
Interpreting Your PEPPER Report Is Much Easier Than You Realize
Use these pointers to clear up confusion. Understanding your skilled nursing facility&... Read more
Test Yourself:
Pinpoint The E/M Code Correctly Every Time
Don’t fall victim to these five pitfalls. Payer guidelines for E/M coding vary a... Read more
Know These Crucial SNF Target Area Definitions
What CMS looks at when finding improper Medicare payments. To understand your Program ... Read more
Industry Notes
OIG Identifies ‘Top Management Challenges’ Practices that live in constant... Read more
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