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Medicare Compliance & Reimbursement

Compliance:
OIG Ups the Ante on Holiday Gift Giving
New giving guideline offers options but also brings a heftier fine. The old saying goe... Read more
Reimbursement:
Know These MIPS Measures for the Advancing Care Information Transition
With two paths for success, MACRA’s new EHR requirements offer options for engagem... Read more
Safe Harbor:
New Safe Harbor Revisions Give Providers Something to Smile About
OIG final rule welcomes the shift to value-based care. As CMS transitions from its Su... Read more
Coding Quiz:
Take a Look at These 6 Coding Examples to Help You in the New Year
Here’s a quick question-and-answer to six common coding worries by specialty. I... Read more
Industry Notes:
Fraudulent Cybersecurity Firm Masquerades As the OCR in Phishing Scam
Plus: There are 2 new CMS Innovation Models to look forward to in the new year. Falli... Read more
Compliance:
Get the Facts on Federal Health Programs' Exclusions
Take a look at the different types of exclusions and what they entail. Consider this ... Read more
5 Things to Remember If You Are Excluded from Medicare
If you happen to find yourself excluded, there are specific guidelines to follow to be r... Read more
Reimbursement:
Check Locum Tenens Rules When Scheduling Your Holiday Coverage
LT restrictions made easy with these tips for filling physician vacancies. Twinkling l... Read more
Take Time to Address These LT and Reciprocal Billing Quandaries
Hiring a locum tenens doesn’t need to be daunting and is actually a great benefit ... Read more
Supply Billing:
Boost Your Bottom Line With 4 Quick Supply-Billing Tips
Remember: 99070 is not a one-size-fits-all materials code. When it comes to billing fo... Read more
Compliance:
Nab ABN, Forget Worries About Uncovered Service
Experts: ABN will build patient trust. Occasionally, a patient will present to the pra... Read more
Industry Note:
CMS Cracks Down on Medicare Providers Caught Overcharging Individuals in QMB
As Medicare shifts from fee-for-service and instead focuses on quality, value-based care... Read more
Industry Note:
Psychiatrist Must Pay Back $908,000 for False E/M Claims
E/M services are a point of contention for many providers, with an oftentimes complex mi... Read more
Compliance:
OIG to Probe Care Management, DMEPOS Compliance, and More in 2017
The latest Work Plan focuses on several new areas of concern for the OIG. Starting Ja... Read more
Reimbursement:
Final MPFS Rule for CY 2017 Supports MACRA's Focus on Primary Care
E/M services, chronic coordination, telehealth at the heart of the finalized policies. ... Read more
Who Were the Winners and Losers in the Medicare Physician Fee Schedule?
Conversion Factor. Physicians can expect a slight increase this year with the conversion... Read more
HIPAA:
Disaster Zone: Be Prepared with HIPAA-Ready, EHR-Contingency Plans
OIG looks for five practice policies when reviewing for compliance after a natural disas... Read more
4 HIPAA-Friendly Tips to Help You Plan Ahead for an EHR Outage
Luckily, the HHS, in coordination with the NIST and the ONC, offers help to providers se... Read more
E/M Coding:
3 Tips Lead to Seamless Consultation Coding
Consult coding is still going strong for some private payers—if you know how to re... Read more
Health IT:
Is Your Practice HIT Up-To-Date with Advancing Care Information?
You have two short months to prep for the implementation of MACRA’s final rule. ... Read more
Industry Notes:
HHS Final Rule for Certified Health IT Defines Limits with Broad CMS Changes Ahead
As CMS moves Meaningful Use (MU) to the side and puts Advancing Care Information (ACI) f... Read more
Reimbursement:
Are You Ready for MACRA?
With the final rule out last month, CMS provides an outline for the future of health car... Read more
Compliance:
Don't Let HIPAA Worries Plague Your Small Practice
Know these compliance basics to avoid HIPAA audits for smaller practices. Since every ... Read more
Benchmarking:
Compare Your Physician Assistant's Modifier 25 Billing with Other PAs
Take a look at a recent CBR on physician assistants, E/M visits, and modifier 25. Ben... Read more
Industry Note:
Increased MACRA Interest Causes CMS to Reopen Advanced APM Applications
With MACRA’s final rule out for interpretation, CMS has been privy to much comment... Read more
Industry Note:
DOJ Gives a Hefty Sentence to a Michigan Physician with a Trifecta of Fraud Charges
Most offenders of Medicare fraud fall into categories of severity, which render the perp... Read more
Industry Note:
States Chime in with ACO Initiatives to Up the MACRA Ante
As the nation shifts to MACRA in a few short months, more states are getting involved wi... Read more
Medicare Errors:
DMEPOS, Home Health, E/M Factor Heavily in the 2015 Fee-For-Service Error Rate
Though CERT data helped decrease errors, improper payments are still in the billions. ... Read more
Compliance:
Billing Blunders Got You in a Bind?
As the Medicare system evolves, billing continues to be a source of consternation for pr... Read more
Clip And Save:
What's On Your Revalidation Checklist?
Know the current revalidation requirements with this handy list of dos and don’ts.... Read more
Reimbursement:
Notes and Necessity Are Essential for Chiropractic Claims to Be Paid
With chiropractic claims, it is wise to consult your MAC on what’s required. Do... Read more
What is Medicare P.A.R.T. Documentation?
When evaluating musculoskeletal and nervous system issues for chiropractic claims, the d... Read more
Industry Notes:
Plug In Your Numbers to See What MACRA Model Is Right for You with New AMA Tool
Plus: New offerings from the ONC help providers address health IT issues With MACRA&rs... Read more
Stark & FCA:
Tuomey Troubles Make Former CEO Personally Liable for &1 Million
Heads up, health care executives: Stark just got personal. Ralph J. Cox III, former ch... Read more
Stark & FCA:
5 Compliance Lessons from the Tuomey Case
How to steer clear of Stark’s “booby traps.” “It seems as if, ... Read more
Stark:
Your Quick-Start Guide to Stark
Feel like you need a Stark law refresher? Or that you’ve never fully understood th... Read more
CMPs:
Crunch Time: FCA, Stark, Anti-Kickback, HIPAA & EMTALA Get Teeth
Compliance blunders just got more expensive. ICYMI: HHS, CMS, OIG and other health car... Read more
EMTALA:
7 EMTALA FAQs
Do you know when the Ophthalmology Department becomes part of the ED? What are your co... Read more
EMTALA Coding Case Study
Sometimes, the EMTALA regulation butts up against billing and coding rules, said complia... Read more
Industry Notes:
Patients and Families Can Sue Long-Term Care Facilities in Court, New Final Rule Says
CMS has released its first major overhaul of nursing home regulations since 1991. The ... Read more
Part B Payment:
Public Comments Shape MACRA QPP Pacing With Plan Options
As the Jan. 1 start date looms large, CMS gives choices to Medicare providers. The fin... Read more
Coding:
Your ICD-10 Honeymoon Is Over
Brace for more than 4,000 new & revised codes in 2017. Part B Providers: Think you... Read more
Billing Compliance:
Why the 60-Day Overpayment Rule is a Qui Tam Waiting to Happen
Like many billing compliance hazards, the 60-day overpayment rule can trip you up &mdash... Read more
Hospital Coding:
Make the Right Observation Code Choice
Make sure the provider is eligible before reporting observation. You know that you mus... Read more
Hospital Coding:
Know What to Do When Observation Stretches the Limits
Keep careful documentation of longer stays. While most patients will be either dischar... Read more
Home Health:
4 States Win Temporary Pre-Claim Review Reprieve
Medicare indicates need for more education. While Illinois Home health agencies are st... Read more
Regulations:
Take 6 Steps Now to Comply with New Nondiscrimination Rules
Section 1557’s gender identity provisions are already facing pushback from religio... Read more
False Claims Act:
SCOTUS Draws Boundaries for FCA and Future Liability
Hint: Common law takes into account both acts of commission and omission. Can fraud b... Read more
Compliance:
Expect Improved Care for Seniors After PACE Updates
Quality of care mandated by ACA to be reinforced with optimal use of advanced technology... Read more
Home Health Reimbursement:
Watch Out for Cash Flow Delays as PCR Launches
Take these pre-emptive measures to avoid furnishing free care. Pre-claim review (PCR) ... Read more
Industry Note:
Prevent, Detect, and Treat Zika with Help from CDC and FDH
At first, the Zika virus seemed to be something to prepare for only when traveling outsi... Read more
Industry Note:
MPPR Updates Boost Radiology Payments
It looks like radiology practices have something to smile about. The Centers for Medicar... Read more
Reimbursement:
Proposed Rule: Enjoy Expanded Coverage for Telehealth Services
Keep an eye out for 8 new CPT® codes to get deserved telehealth reimbursement. If ... Read more
Pay Attention to Future POS Code Changes for Telehealth
Meanwhile, stick to using the code applicable to the patient’s location. In addi... Read more
MACRA:
Alternative Approaches to Achieving MACRA Objectives Under Consideration
Physician advocacy groups cheer Slavitt flexibility. The deadline for putting into eff... Read more
Reimbursement:
You Could Be Forfeiting $26,000 Annually
Always investigate denials for 90460 — here’s why. For most pediatric prac... Read more
Compliance:
Get a Handle On the Basics of On-Call Arrangements
Tip: OIG suspicious of fraud in the guise of on-call coverage. If your facility has an... Read more
Industry Note:
Get Up to Speed On 2017 ICD-10 Codes
You’ve got only a few short months to get up to speed on the new ICD-10 diagnosis ... Read more
Industry Note:
Medicare Claims System Fix On Deck
A claims system correction should clear up returned and held claims due to an error in t... Read more
Industry Note:
Part D Prescription Drug Premiums Remain Status Quo
The cost of health care continues to be on the rise, and there’s no place that it ... Read more
Reimbursement:
Good News: Look for Pay Boosts in 4 Primary Care Areas
Massive PFS proposed rule also aims to make 10 other significant changes. Get ready to... Read more
Expect The Diabetes Prevention Program to Expand Within Medicare
Voice your opinions on 9 key issues for DPP expansion. For the first time ever, the Ce... Read more
Reimbursement:
Proposed Fee 2017 Schedule Closely Aligned to MACRA
CMS putting its money where its mouth is, Slavitt says. Prevention, wellness, and appr... Read more
Compliance:
Don't Trip Over Financial Incentives and Relationships
Note: Kickbacks could be more damaging than self-referrals. Enhanced data analytics al... Read more
Home Health Compliance:
Don't Miss Your Chance to Post Your PPS Rule Comment
Reminder: Use new billing software after Oct. 1. If you haven’t taken a look at ... Read more
Industry Note:
New Patient-Centered Initiatives to Improve Healthcare Delivery
Most providers enter the health care industry with a yearning to serve and help the comm... Read more
Industry Note:
Digitization Jeopardizes Health Information More
Health technology that keeps our nation fit and able abounds and impacts lives everywher... Read more
Industry Note:
Well-Planned Discharges Key to Avoiding Readmissions
The old saying “haste makes waste” suggests that timely planning is key to l... Read more
Reimbursement:
How The New Oncology Care Model Will Test Major Medicare Pay Changes
Will the OCM overwhelm practices already overburdened by too many APMs? The much-antic... Read more
By The Numbers:
What's The OCM's Potential Impact?
New model could save CMS billions of dollars in wasted cancer drug payments. The newly... Read more
Compliance:
SMP Helped Recapture More Than $2.5 Million
SMART FACTS replaced with SIRS. The Centers for Medicare & Medicaid Services (CMS)... Read more
Home Health Prospective Payment System:
Truncated Reimbursement in 2017 Spells Woes for HHAs
Patients might suffer equally. Rebasing, reshuffled case mix, and reduced home health ... Read more
Industry Note:
HHS Pledges $20 Million to Train Small Practices
In an effort to reach out to the little guy, the Department of Health and Human Services... Read more
Industry Note:
Get the Latest SNF Trends
If you’re curious about trends in nursing home enforcement activities, you have so... Read more
Industry Note:
AMA Concerned Over Ethical Use of Telemedicine
As telemedicine use has increased to remotely diagnose and treat patients via vario... Read more
Industry Note:
New Fire Safety Requirements Hit Hospices This Summer
Check Medicare’s latest fire safety requirements to see whether your hospice inpat... Read more
Industry Note:
OIG Uncovers Medicare Fraud Ring
The HHS Office of Inspector General (OIG) continues to radar in on Medicare referral fra... Read more
ACOs:
Heads Up: CMS Is Changing the Way Medicare Pays ACOs Under The MSSP
Not yet ready to take a big financial risk? Now you can get an extra year of breathing r... Read more
MSSP:
ACOs: Get Ready for CMS to Change the Way It Rebases Your Benchmark
But don’t expect your benchmarking methodology to change until the second year. ... Read more
Compliance:
Your Top Priority: An Airtight Practice Compliance Program
Reductions in fines tops the list of benefits. If your practice participates in Medica... Read more
Inpatient Facilities:
Welcome Clarity On Inpatient/Outpatient Status
However, whether beneficiaries will get more information of payment implications is stil... Read more
Hospice Regulations:
Expect Hospice Bookkeeping Nightmares to Continue
Proposed changes to the Hospice Item Set tool to align HIS to other post-acute care sett... Read more
Industry Note:
Utilize Help from MLN Videos to Avoid Denials
The Medicare Learning Network (MLN) aims to assist providers and their staff members wit... Read more
Industry Note:
Nondiscrimination Requirements Get More Stringent
You’ll need a new notice of nondiscrimination for your patients, based on a final ... Read more
Fraud:
Overpayments Are So Last Year -- Now, CMS Will Just Not Pay Your Claims
CMS goes high-tech with fraud-fighting efforts of the 21st century. “Big data&rd... Read more
3 Examples:
FPS 'Big Data' Can Spot Fraudulent Medicare Claims
Predictive analytics spot over-billing and more, leading to revocation. With crystal b... Read more
Reimbursement:
Avoid These 5 Slips to Keep Your Practice Running Smoothly
Hint: Hire certified staff and investing in new software. Improper coding, inexperienc... Read more
Enforcement:
HEAT Nets 5-Fold Increase in CMP Recoveries
Enforcements help honest providers flourish, says OIG. Can you prove that every servic... Read more
Home Health Prior Authorization:
CMS Springs An Unpleasant Surprise On HHAs
Beneficiaries of home healthcare could soon face access issues. The Centers for Medica... Read more
Industry Note:
Use This Resource to Overcome Medical Errors
Mistakes are made, and sometimes lives are lost in medicine. Promoting the feelings of t... Read more
Industry Note:
Future Physician-Patient Dialogues Could Be Restricted
In yet another twist on the national debate on gun control, a federal court will soon we... Read more
Compliance:
Watch Out: OIG Targets EHRs & SNFs for Fraud, Waste & Abuse
OIG won’t let go of its mission to reform SNF therapy payments. You could face ... Read more
Want to Know What's On the OIG's Hit List? Here Are the Top 10
Health IT and prescription drugs top the list of significant challenges. Many of the H... Read more
Compliance:
Keep Clear, Concise Notes -- Or Face Paybacks
Tip: Ensure your coders get all the documentation upfront. You could face charges of o... Read more
Reimbursement:
Safeguard Your Reimbursement with These Incident-To Essentials
No plan of care could jeopardize payment. If you don’t master the basics of inci... Read more
Regulations:
Enrollment Changes Could Cost You Dearly
Medicare beneficiaries will likely pay a price, too. The items you report when you enr... Read more
Industry Note:
CMS Updates ICD-10 with Specialty Support
With the release of ICD-10 revisions slated for Oct. 1, 2016, CMS continues to add infor... Read more
Industry Note:
Track Your ICD-10 Progress to Avoid Denials Come October
Not sure where you stand in terms of your ICD-10 progress at this point? The Centers for... Read more
MACRA:
Next Step: Meaningful Use Out, New Program in -- What You Need to Know
Advancing Care Information eliminates the ineffective ‘one-size-fits-all’ ap... Read more
Advancing Care Information:
How to Earn Maximum Points in the MIPS Scoring System
You must report a ‘yes’ attestation for patient data security. As the Mean... Read more
MACRA:
HHS Introduces Two Different Payment Models
Industry expects changes will usher in a new era of excellence and innovation in medicin... Read more
Annual Wellness Visits:
Get This Confusing Coding Scenario Clarified
he key is to demonstrate the separate nature of the additional E/M service, says Palmett... Read more
Healthcare IT:
Make Healthcare Technology More Accessible
Proposed rule aims to reinvigorate medical technology. The Department of Health and Hu... Read more
Compliance:
Know When the 60-Day Clock Starts Ticking
You’re responsible for determining whether you’ve received overpayments, say... Read more
Hospice:
Watch Out for Regulatory and Compliance Hot Spots
Will your documentation pass muster? The Centers for Medicare & Medicaid Services ... Read more
Industry Note:
HHS Aims to Revamp CHIP And Medicaid
In an effort to provide greater clarity and responsibility while offering superior manag... Read more
Industry Note:
CMS Wants You to Use JW Modifier
Mark your calendars for July 1, 2016 — on this date, the new Centers for Medicare ... Read more
Reimbursement:
Get Ready: New Alternative Payment Model Promises to Transform Primary Care
But CPC+ model could create dire problems for ACOs’ MSSP participation. In a fur... Read more
Understand the CPC+ Model's 5 Key Components
Can you provide enhanced office hours and 24/7 access? Before you jump on-board with t... Read more
Reimbursement:
Primary Care Doctors Celebrate the Shift
When the Centers for Medicare & Medicaid Services (CMS) rolled out the Comprehensive... Read more
Revenue Booster:
Cut Down On Errors to Maximize Cash Flow Like this Solo Practitioner
Tip: Instituting low-cost technology enables you to pay closer attention to detail. Ti... Read more
Replace Poorly Scribbled Notes with Technology
Tip: Focus on your patients, not your notes. If you repeatedly face downcoded or denie... Read more
Compliance:
OIG Takes Aim at Outpatient Payments
Plus: EHR efforts fall short. The HHS Office of the Inspector-General’s (OIG) la... Read more
Home Health Compliance:
Flawed Pilot Vexes Home Care Industry
Prior authorization not the only provision in CMS notice that may affect you. Medicare... Read more
Industry Note:
Rampant E/M Overbilling Prompts Violations and Millions in Fines
The Department of Justice (DOJ) continues to crack down on fraudulent E/M claims. The la... Read more
Industry Note:
AHA Warns About New Digital Attacks
As hospitals strive to become more efficient and tech savvy with the increase of electro... Read more
Reader Question:
Tell the Payer What You Are Coding For
Question: When should I use modifier 26? Answer: CPT® designed modifier ... Read more
Reimbursement:
How New Diabetes Prevention Program Blazes Trails for Medicare
Physician organizations are backing Medicare coverage expansion for NDPP. Generally la... Read more
Model Program Results:
Understand The NDPP's Overall Potential
Growing diabetes epidemic is costing Medicare staggering amounts. The innovative 2012 ... Read more
PHI:
Plan How You'll Handle Ransomware Attacks
Beware: You might have to pay to access your own patient files. Your PHI is being held... Read more
Documentation:
Polish Your Recordkeeping Skills to Face Any Kind of Review
Tip: Abbreviations could be your downfall. Unless your medical records are as airtight... Read more
Fraud Control Measures:
Is Reduced Reimbursement for Hospice Residents in Nursing Homes On the Horizon?
MedPAC zeroing in on discrepancies. The significant difference in key statistics for h... Read more
Industry Notes:
Medicare Advantage Pay to Rise by 0.85 Percent
Looking for a boost in your Medicare Advantage payments? CMS is prepared to oblige, but ... Read more
Industry Note:
Oklahoma Slashing Medicaid Pay
Providers in Oklahoma are about to see a significant pay cut for their Medicaid claims, ... Read more
Industry Note:
Physician Under Fire for Outsourcing Surgical Monitoring Services
A Georgia physician is in hot water with the feds after agreeing to perform intraoperati... Read more
Reader Question:
Do You Have the 96 Hour Emergency Responsibility?
Question: According to the Joint Commission standards, are organizations supposed t... Read more
Reader Question:
When Multiple Providers Treat a Patient,Who Reports the Discharge?
Question: Our patient has a complex health history, and is therefore under treatmen... Read more
Part D:
Are You Part of the 'Opioid Epidemic?' Get Ready for Big Changes
Stakeholders also dislike PDMP review requirement in another proposed rule. The ... Read more
Learn What Else CMS Has in Store for MA & Part D Plans
CMS wants to waive the bid requirements for MA EGWPs. In addition to the opioid use pr... Read more
Compliance:
Expect Enhanced Scrutiny of Diagnostic-Only ED Visit Claims
Double check whether a doctor saw the patient. If you bill for an emergency department... Read more
Modifiers:
Know When to Use Modifier 51 -- and When Not To
Navigate conflicting preferences with this expert advice. Be cautious when using modif... Read more
Compliance:
Teaching Physicians Must Meet Higher Critical Care Documentation Standards
Tip: Go by the book. The teaching physician section in the Centers for Medicare and Me... Read more
Industry Note:
CMS Adds CRNAs to Telehealth List
Practices that are eager to use the Medicare telehealth benefit have a new option &mdash... Read more
Industry Note:
CMS Creates Proposal for New Medication Injection Payments
In its ongoing effort to pay physicians based on quality of care and to cut costs, CMS h... Read more
Reader Question:
Use 25 with New Prolonged Services Codes to Max Out Payment
Question: A 25-year-old new patient reports to the gastroenterologist complaining o... Read more
Reader Question:
Only Report Time that Directly Contributes to the Treatment of the Critical Patient
Question: How is physician time measured for the purpose of reporting critical care... Read more
Reader Question:
Vaccines May Not Comprise Just One Code
Question: Do flu vaccines always require two codes? Answer: Yes, according t... Read more
Reimbursement:
Brace Yourself for Lower Medicare Part B Drug Payments
Find out what the 6 new experimental models will look like. You may soon see radical c... Read more
Why New Part B Drug Model Could Hit Oncology the Hardest
Could prior studies have already proven opposite results? Oncologist organizations hav... Read more
HIPAA:
Are You Prepared for HIPAA Audits?
Awareness is outpacing steps toward compliance, says a recent report. Implementing a c... Read more
HIPAA:
8 HIPAA Training Skills That You Can't Afford to Ignore
Prevention is still better than dealing with the aftermath of a breach. Helping your s... Read more
Face-to-Face:
12 Ways to Stay Ahead in the F2F Race
Warning: Pay attention to what’s in the mail. The results of Medicare’s Pr... Read more
Industry Note:
What Ever Happened to 'Sequestration' Cuts?
Do you remember back in 2013 when the Centers for Medicare & Medicaid Services (CMS)... Read more
Industry Note:
Relay Health Sees Just 1.6 Percent of ICD-10 Claims Denied
While health care providers continue to report positive results with ICD-10 claim submis... Read more
Industry Note:
CMS Reminds Practices that OIG is Still Using Analytics Software to Find Errors
On Feb. 26, the HHS Office of the Inspector General (OIG) released its Health Care Fraud... Read more
Compliance:
What The 60-Day Final Overpayment Rule Has in Store for You
And 3 key strategies you can employ now to avoid big problems. Thanks to a new final r... Read more
Compliance:
Take a Closer Look at 3 Other 60-Day Rule Provisions
You’re still subject to the rule, even if the overpayment wasn’t your fault.... Read more
Compliance:
Know the Regulations Like the Back of Your Hand
Keep in mind that compliance is a multi-step process. Feeling completely up to speed o... Read more
Payer Updates:
Get to the Bottom of These Pressing Issues
Navigate the Medicare billing and coding arena with help from the MACs. Medicare rules... Read more
Industry Note:
EHR Hardship Exception Application Doesn't Prevent You from Meeting MU Requirements
If you’ve submitted an EHR hardship exception, you might be thinking you have to k... Read more
Industry Note:
Phone App Developers Could Be Considered Business Associates in Certain Instances
Phone apps go beyond Angry Birds and Pandora these days — and some are so advanced... Read more
Industry Note:
Louisiana Health Network Discloses Possible HIPAA Breach
A suspicious download has led to the potential breach of 13,000 Medicaid patients’... Read more
EHRs:
Game Changer: Can You Say Goodbye to the EHR Incentive Program?
Make sure your EHR provider is keeping up with these changes. The latest breaking news... Read more
Electronic Health Records:
Your EHR Hardship-Exception Application Process Just Got Easier
New law also toughens penalties for Medicare/Medicaid identity theft. Although the Cen... Read more
Accounts Receivables:
You Could be Bleeding Cash if You're not Following These A/R Tips
Collect all the reimbursement you deserve. All that effort which went into staying on ... Read more
How to Quickly Calculate Your Days in A/R
Collections can be hard enough to manage without mastering all the jargon as well. But w... Read more
E/M Coding:
These Errors Could Lead to Recoupments After Audits
Does your medical decision-making support the level of service billed? If 65 percent o... Read more
Industry Note:
CMS: Stop Balance Billing QMB Patients
If you see qualified Medicare beneficiaries (QMBs) — those patients who are eligib... Read more
Industry Note:
Duplicate Claims can Cause Double the Trouble
Medicare is just as eager to pay your claims as you are to collect them. That was the ta... Read more
Industry Note:
Watch Out for HIPAA 'Teeth' Biting You in 2016
The HHS Office for Civil Rights (OCR) closed out 2015 with a booming December for health... Read more
Industry Note:
Medical Practices Continue to Boost IT Budgets
If you thought your EHR investment would be your last IT expenditure for a while, you co... Read more
Industry Note:
CMS Debuts New Face-to-Face Home Health Clinical Template
Physicians who certify patients for home health care were seeking more help with what th... Read more
Industry Note:
Payer Misplaces PHI of Nearly One Million Patients
  Your practice would be in quite a bind if it misplaced the protected health inf... Read more
Reimbursement:
Get a First Look at New Quality Measures in CMS' Volume-To-Value Evolution
Brace yourself for CMS to rate you on these six quality domains. You know that audacio... Read more
Watch Out for 7 Potential MDP Implementation Problems
You can likely expect worsening administrative burdens, CMS admits. The newly release... Read more
Advance Care Planning:
Here's the Lowdown on How to Bill ACP Properly
CMS has some clarifications for you. If you have been wondering how to bill the two co... Read more
Part B Revenue Booster:
Boost This Year's Cash Flow with These Expert Pointers
Watch for trends of 2015 to avoid hurting your bottom line. Are you hoping to avoid la... Read more
Teaching Physicians:
Get the Scoop On When to Report Telehealth
Hint: The teaching physician needs to furnish all key critical elements of the service. ... Read more
Budget:
What Is Marginal Profit?
Get to know the new term that’s helping policymakers decide your fate. “Ma... Read more
Industry Note:
Get Ready for Overhauled EHR Incentive Program
CMS projects that by the end of this year, 30 percent of Medicare payments will be linke... Read more
Industry Note:
CCI Takes Aim at New Prolonged Service Codes
Just as quickly as several new CPT® codes went into effect, the new edition of the C... Read more
Reader Question:
Don't Change POS for SNF Patient in Office
Question: We have a scenario where our physicians are seeing skilled nursing facili... Read more
Breaking News:
President Obama Vetoes Repeal of the ACA
The Republicans’ party short-lived. On Jan. 6, the House of Representatives vot... Read more
Compliance:
Prior Authorization Final Rule Will Transform DMEPOS Reimbursement
Lower limb prosthetics could suffer unfair targeting by new regulation. Getting Medica... Read more
Medical Supplies:
Beware of 3 Possible Drawbacks to the New DMEPOS Rule
Why some stakeholders believe CMS is unfairly including leg prostheses. When the Cente... Read more
Compliance:
Celebrate CMS' Modification of Over Two-Midnight Rule
Medical predictability of adverse event could be the decider of patient status. The Ce... Read more
Compliance:
Remember That Not All Providers May Opt Out of Medicare
Know the difference between a covered service and a service that is reimbursable. Comp... Read more
Industry Note:
New 'Excludes1' Guideline Could Change Your Diagnosis Coding
You’ve been using ICD-10 for nearly four months now, so it’s likely that you... Read more
Industry Note:
MedPAC to Call for Another HHA Pay Cut in 2017
Soon, the Medicare Payment Advisory Commission (MedPAC) won’t be able to... Read more
Reimbursement:
How New CJR Rule Incentivizes Hospitals to Better Coordinate Care
Delayed start date gives you more time to prepare, but overall pacing won’t change... Read more
Joint-Replacement Model:
Did Your MSA Make the Cut?
Most excluded markets have less than 400 CJR eligible volumes. Under the Comprehensive... Read more
Revenue Booster:
Tighten Up Your Processes to Increase Your Collections by Thousands
Tip: Remember to collect copays at the front desk. Even simple lapses in recording pat... Read more
Error Rates:
Nail Down Your E/M Claims to Stay Off the Audit Hit List
Relationship with the coder and the education of the physician are critical. The lates... Read more
HIPAA:
Senators Want HHS to Clear Up Confusion Over Medical Identity Theft and HIPAA
You and your patients may soon see more support from the federal government when it come... Read more
Industry Note:
EHR Incentive Payments Are Valuable -- But Not This Valuable
Medical practices and facilities that used electronic health records (EHRs) anxiously aw... Read more
Industry Note:
RACs Could Face Limits Very Soon
CMS is reining in its Recovery Audit Contractors (RACs) somewhat, but it may not stay th... Read more
Industry Note:
Yes, You Can Translate Your Own Handwriting for MAC Review
When Medicare payers come calling for your documentation to support claims, you may be f... Read more
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