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Medicare Compliance & Reimbursement

Medicare Physician Fee Schedule:
CMS Solidifies Some Telehealth Changes
Plus: E/M payment and documentation updates finalized. After Medicare's epic twists a... Read more
Get the Scoop on 5 Fee Schedule High Points
Hint: MVP is a go in 2021. If you're searching for what's hot in the calendar year (CY) 2... Read more
Reimbursement:
Find Out the 2021 MPFS Winners and Losers
Hint: Endocrinologists can expect some big gains next year. There's no denying that 2020 ... Read more
Coding Errors:
HHS Report Outlines Biggest Areas of Concern
Tip: Concise documentation will be critical in 2021. Medicare hasn't released all the ann... Read more
Cybersecurity:
Boost Texting Protocols With Expert Advice
Are you guarding against ‘smishing' threats? Due to social distancing requirements, you... Read more
Industry Notes:
CDC Offers COVID-19 Vaccination Toolkit
Tip: Prepare staff for questions on the new vaccines. If your phone is ringing off the ho... Read more
Compliance:
CMS Delivers Surprise Stark Update for the Holidays
Final rule gifts providers with exceptions galore. Despite a raging pandemic, fraud and ... Read more
Revenue Booster:
Beef Up Your Remote Coder Policies With These Steps
Tip: Set limits on IT to ensure patient privacy and security. Timely, trustworthy coders ... Read more
Enforcement:
Feds Target Experts’ Speaker Fees in OIG Fraud Alert
Hint: Expect scrutiny to ramp up post-COVID. If you didn't have speaker fees on your frau... Read more
Reader Questions:
Pocket This ICD-11 Insight
Question: Is there any update on ICD-11? Georgia Subscriber Answer: While ICD-10 revisi... Read more
Industry Notes:
‘Corrective Actions’ in Home Health, SNF Impact Rate Drop
If you've been waiting patiently for Medicare's annual improper payment rate data, you're ... Read more
Industry Notes:
Use Handy QPP Tools to Check PY 2021 APM and MIPS Status
With all the Quality Payment Program (QPP) regulatory rollbacks to accommodate COVID-19, y... Read more
Industry Notes:
Care Compare Is Here to Stay
Whether or not you were ready to move on, the old Compare sites are now defunct. On Dec. ... Read more
Industry Notes:
OIG Adds Two-Midnight Rule to Work Plan
If you thought your short-stay inpatient claims were good to go, you'd be wrong. In a stun... Read more
Reader Questions:
Know the Facts on COVID Swab Collection
Question: Our practice needs COVID-19 testing advice. If one of our clinicians does a tele... Read more
COVID-19:
Feds Debut Future Vaccine Cost-Sharing Policies
See new COVID-19-related details on Medicare extensions and payments. If your head is sp... Read more
HIPAA:
Derail Ransomware Attacks With Stronger HIPAA Protocols
Understand what ‘low probability of compromise' means. Recent proof confirms that you ... Read more
Medicare Billing:
Squash Modifier Mishaps With 12 Top Tips
Tip: Learn modifiers' differentiated roles to boost revenue. It's not surprising that ... Read more
Reader Questions:
Get the Facts on ABN Form Postponement
Question: Our practice thought the new advance beneficiary notice (ABN) form was supposed ... Read more
Industry Notes:
Get Your QPP Hardship Application in Before the Deadline
Plus: Feds push information blocking compliance to next year. If your Merit-Based Incent... Read more
Industry Notes:
In other news …
The recently finalized data sharing mandates set to go into effect on Nov. 2 have been res... Read more
Vaccinations:
See New Federal Guidance on Flu and COVID-19
Tip: Make safety a priority this year. Flu clinics are a hallmark of many Medicare provid... Read more
Reimbursement:
Know These 10 Facts on Roster Billing
Tip: Review the basics before submitting claims. For many Medicare providers, the fall fl... Read more
Procedure Coding:
Master Immunization Coding With This FAQ
Tip: Don't forget about two crucial coding exceptions. As the nation heads into a third c... Read more
Reader Questions:
Add These Electronic Signature Tips to Your HIPAA Wheelhouse
Question: Our practice still sees a majority of our Medicare beneficiaries via telehealth ... Read more
Reader Questions:
Pocket the Particulars on New PHE PPE Code
Question: Can you offer some guidance on the new CPT® code for reporting additional pract... Read more
Industry Notes:
Feds Add Several COVID-19 Policies to OIG Work Plan
Plus: OCR amplifies focus on HIPAA Right of Access.  If you thought things were alr... Read more
Coronavirus Round-Up:
Check Out 4 New COVID-19 Updates
Caution: Stay on top of PHE-related regulatory changes. Recent COVID-19 statistics point ... Read more
Reimbursement:
Get the Scoop on Medicare AAP Recoupment Relief
Tip: Follow up with CMS on how much you owe ASAP. With the pandemic still smashing Medica... Read more
Benchmarking:
Find Out If Your NPs’ High-Level E/M Reporting Is Above Average
Caution: Don't use the same code for every visit. Chances are your nurse practitioners (N... Read more
HIPAA:
What Is an IT Asset? Find Out
Tip: Use risk analysis as a tool to protect your IT assets. As the pandemic rages on, pro... Read more
Industry Notes:
Feds Hope to Boost Physicians’ EHR Usage
Hint: Expect heightened focus on IT in the future. The Department of Health and Human Ser... Read more
Rural Healthcare:
Get the Scoop on New Programs and Updates
Tip: CMS offers tools aplenty for rural providers. COVID-19 numbers are on the rise agai... Read more
Provider Relief Funding:
Review the Latest PRF Reporting Change
Warning: You may have to pay back funds. If you've been patiently awaiting the reporting ... Read more
House Passes Medicare AAP Program Update
Bill gives providers more time to repay loans. If you've put COVID-19 payment recoupment... Read more
Medicare Appeals Quiz:
Test Your Appeals Know-How With 5 Tough Questions
Tip: Timelines vary by appeal level. Whether you're a Medicare claims novice or master, a... Read more
Medicare Appeals Quiz:
Test Your Appeals Know-How With 5 Tough Questions
Tip: Timelines vary by appeal level. Whether you're a Medicare claims novice or master, a... Read more
Compliance:
Master AWVs With Tips from the Experts
Differentiate your claims with the right ICD-10 code. The threat of COVID-19 has caused... Read more
Fraud & Abuse:
Don’t Expect the Stark Update Until 2021
Address financial arrangement concerns now before the PHE ends. If you thought the endle... Read more
Enforcement:
Find Out Individual Risks of Healthcare Fraud
Tip: Make compliance with federal regs a priority. It's no secret that healthcare is a to... Read more
Take a Look at 2 Recent Fraud Cases
Even friends and family can get pulled in by enforcement. As the feds delve more deeply in... Read more
E/M 2021:
Get the Scoop on E/M Highlights from CPT® 2021
Find out about new codes and descriptor revisions. Now that the new edition of CPT® is ... Read more
Cybersecurity:
Curtail Vishing Schemes With VPN Protocols
Tip: Avoid discussing work on social media. COVID-19 has caused many Medicare providers t... Read more
Industry Notes:
2020 QPP Payment Year Data Is Now Available for APMs
Tip: Have your HARP credentials handy to log in. The Centers for Medicare & Medicaid ... Read more
Reimbursement:
Get the Scoop on QPP 2021 Proposals
Don't expect MVP until at least 2022. If you were looking forward to major Quality Paymen... Read more
Billing:
Test Your Medicare Smarts With Claims Q&A
Tip: Logs can help identify illegible signatures. Ensuring that Medicare claims are corre... Read more
ICD-10 Coding:
Differentiate Substance Abuse With New Diagnosis Code Options
Tip: Updated guidelines offer clarification on vaping. There's only one month until the n... Read more
See COVID-19 Diagnosis Code Update
Boost ICD-10 coding with 7 COVID-19-specific scenarios. With coronavirus not expected to ... Read more
Industry Notes:
Know the PRF Details on Sales and Purchases
Tip: Read the fine print. If you're planning on selling off practice assets connected to ... Read more
Reimbursement:
Feds Propose Major Cut to Conversion Factor
Plus: See E/M updates, telehealth expansion details, and more in PFS. If you were hoping ... Read more
E/M Coding:
Fortify E/M Claims With HPI Calculation Mastery
Documentation is key to ensuring clean claims. As the year starts to wind down, your prac... Read more
Telehealth:
Prepare for Telehealth Claims Audits With Expert Advice
Tip: Make sure the notes are clear cut. Now that Medicare audits are back in full swing, ... Read more
Add These Items to Your Telehealth Notes
It's critical that you guarantee your telehealth and phone visits measure up during provid... Read more
Industry Notes:
HHS Extends Phase 2 PRF Application Deadline
Plus: Feds offer natural disaster planning advice during COVID-19. The Department of Heal... Read more
COVID-19 Round-Up:
Expect More Policy Changes With PHE Extension
Claims reviews are back. As coronavirus spikes across the nation, Medicare continues to t... Read more
Provider Relief Funding:
See New Details on PRF Reporting
Tip: Watch for changes to HHS dates and deadlines. It's critical to stay on top of COVID-... Read more
Documentation:
Improve Practice Communication With Query Advice
Tip: Categorize queries to avoid missteps. If you're updating your coding practices to pr... Read more
Reader Question:
Know HIPAA Rules on Contacting Prior COVID-19 Patients
Question: We've performed an abundance of COVID-19 tests at our practice. Recently, we rea... Read more
Industry Notes:
Get the Scoop on COVID-19 Counseling Payments
If you're testing patients for COVID-19 and counseling them on self-isolation, you can now... Read more
Industry Notes:
OIG Adds AAP Expansion to Work Plan
With audits and paybacks in full swing, the HHS Office of Inspector General (OIG) added th... Read more
Industry Notes:
MAC Gives Advice on Accelerated Payment Recoupment
Even though the nation is still in the throes of a pandemic, the feds are still forging ah... Read more
Industry Notes:
APMs Can Check First 2020 Snapshot on QPP Tool
The first snapshot of Performance Year (PY) 2020 data for Alternative Payment Models (APMs... Read more
COVID-19:
See Tax Update on Provider Funding
Tip: Check feds' FAQs daily for COVID-19 changes. Whether you're still waiting for CARES ... Read more
HIPAA:
Don't Ditch Compliance During the Pandemic
Reminder: Enforcement discretions are not forever. Among the feds' top COVID-19-inspired ... Read more
Legislators Hope to Make Telehealth Changes Permanent
Many providers have come to depend on telehealth during these trying times. Not only has t... Read more
Industry Notes:
Claims Reviews Slated to Restart in August
If reports are accurate, the Medicare claims review reprieve may be coming to an end — s... Read more
Industry Notes:
Paper Checks Go Away for Medicare Enrollment Refunds
You can stop looking in your mailbox for that Medicare Enrollment application fee refund â... Read more
Industry Notes:
MAC Offers Advice on Denied Accelerated Payments
If your access to Medicare accelerated payments for COVID-19 relief has been thwarted, a M... Read more
Quality Payment Program:
Feds Offer Telehealth-Related eCQM Update
Caveat: Some measures may not be possible under the expansion. If you're revisiting your ... Read more
Reader Question:
Sidestep Medication Management Coding Snafus With These Tips
Question: What codes should we use for attention deficit disorder (ADD)/attention-def... Read more
Reader Question:
Documentation Is Key for Clean Telehealth Claims
Question: Like many Medicare practices, we've taken advantage of the telehealth expansion ... Read more
Regulatory Relief:
New Office Boosts Feds' Administrative Relief Efforts
COVID-19 rollbacks, interoperability updates factor into policies. If you feel overwhelme... Read more
Billing Quiz:
Check Your Medicare Smarts With These Pointers
Tip: Consider utilizing an MSP questionnaire. Navigating Medicare claims can be tricky ev... Read more
Reimbursement:
Know These Important Details on the New PPP Law
See interim final rule clarifications on bonus and hazard pay. Sifting through all the ... Read more
Reader Questions:
Use This Insight to Bill for N95 Masks
Question: One safety measure our practice has implemented during the COVID-19 pandemi... Read more
Industry Notes:
Watch Out for Phone Scammers Posing as OIG
A recent scam alert suggests that you should be extra cautious of giving your personal inf... Read more
Industry Notes:
Nursing Home Patients Allege CARES Act Payment Theft
Many patients residing in nursing homes have received CARES Act stimulus checks — and sh... Read more
Industry Notes:
Get Ready for Updated ABN Forms in August
If you're updating your compliance protocols, you may want to add the updated Advance Bene... Read more
Reader Questions:
Expect 2019 MIPS Adjustments in the Near Future
Question: We submitted our 2019 Merit-Based Incentive Payment System (MIPS) p... Read more
Interoperability:
New Federal Policies Prioritize Patient Access
Tip: Prepare now for health IT requirements or risk censure. There's no denying that data... Read more
Compliance:
Know These 5 Interoperability Policies
Hint: Data blocking faux pas will go live eventually. With pandemic woes on the front bur... Read more
Cybersecurity:
5 Pointers to Sidestep Phishers
Warning: Investigate before you click. As you reshape your practice protocols to address ... Read more
ICD-10-CM:
Utilize These COVID-19 Coding Updates
Tip: Check out the relevant Z codes. With states and regions slowly opening back up due t... Read more
Reader Question:
Register These HCPCS, CPT® Differences
Question: When should we report HCPCS Level II codes versus CPT® codes? Are HCPCS Level ... Read more
Industry Notes:
See New CDC Testing Update
Plus: Medicaid providers finally receive CARES Act assistance. If you're getting ready to... Read more
COVID-19:
See CARES Act Relief Fund Extensions
Tip: Check HHS website daily. If you're flummoxed by all the CARES Act Provider Relief Fu... Read more
Paycheck Protection Program:
Get the Scoop on PPP Loan Forgiveness
Expect the level of scrutiny to match the amount borrowed. If you applied for a Paycheck... Read more
Telehealth Services:
Pocket 5 MAC Tips on COVID-19 Telehealth Updates
Tip: Know the documentation requirements. Even if you're not on the frontlines during t... Read more
Reader Question:
Feds Offer a Pass on Medicare Claims Reviews During Pandemic
Question: We keep checking our Medicare carrier's website for the Targeted Probe and Educ... Read more
Industry Notes:
Add Handy New Summary to Your COVID-19 Resources
Plus: CMS Suspends 2% Payment Adjustment. If you're overwhelmed by the number of COVID-... Read more
Coronavirus:
See the Latest Round of COVID-19 Updates
Tip: Check CMS guidance before you submit claims. These unprecedented times — and the r... Read more
Revenue Booster:
Bolster Your Bottom Line With 3 A/R Steps
Use benchmarking to fix your issues. With the pandemic wreaking havoc on both the healthc... Read more
HIPAA:
Obtain Authorizations Before Cameras Roll
Privacy requirements still matter in a pandemic. If you turn on the news these days, you'... Read more
Reader Question:
Know These Modifier CS Essentials
Question: With all the COVID-19 billing updates coming down the pike, our practice is conf... Read more
Reader Question:
Get the COVID-19 Facts on CR Modifier and DR Condition Code Usage
Question: Are Medicare providers supposed to be using the CR modifier or DR condition code... Read more
Industry Notes:
Post COVID-19 Testing Prices Upfront
If your organization has COVID-19 testing capabilities, the cash price of the diagnostic t... Read more
Industry Note:
OIG Adds Whopping 25 Issues to Work Plan in May
If you thought the feds might slow down their enforcement activity as providers struggle w... Read more
Industry Note:
Compare Your CARES Act Funding With Other Specialists
If you're curious about what others in your field are borrowing from the CARES Act Provide... Read more
Industry Note:
CMS Pushes MFA Requirement Deadline for PECOS, NPPS, and I&A
As the feds roll out more regulatory relief in times of COVID-19, you can take another adm... Read more
Enforcement:
Know These Stark and AKS Waiver Updates
Tip: Plan ahead for your post-COVID-19 compliance transition. During the best of times, ... Read more
COVID-19 Funding:
Compare These COVID-19 Funding Programs
Urgent: Feds halt accelerated payment applications. If your practice is in need of financ... Read more
Finance:
Prepare Now for Audits From COVID-19 Funding
Document where your reimbursement is coming from — and how you're using it. Now that th... Read more
Quality Payment Program:
Get MIPS Credit for COVID-19 Clinical Trial Data
Bonus: The improvement activity carries a higher-than-average weight. If you're still c... Read more
HIPAA:
Rein in Your Risks Before a Crisis Hits
Tip: Rank your potential risks — and address them with a plan. Even though certain par... Read more
COVID-19 Round-Up:
Know These 5 Important COVID-19 Updates
Tip: Register new CDC guidance. As the feds release, retract, and change COVID-19-related... Read more
Reimbursement:
Know 2 COVID-19 Funding Options
Be aware that both carry stipulations attached to the reimbursement. If your Medicare pr... Read more
Medicare Telehealth Policy:
Know These COVID-Specific Telehealth Service Basics
Hint: Home visits, critical care are included now. Medicare Part B providers can now perf... Read more
Virtual Care:
Pocket This Telehealth Coding and Coverage Primer
Tip: Understand the basics of the 4 virtual service options. If your practice is rampin... Read more
Quality Payment Program:
CMS Offers COVID-19 Relief for QPP Participants
Know the extreme and uncontrollable circumstances policy update. The feds realize that c... Read more
COVID-19:
Feds Ease Up on HIPAA Under Telehealth Expansion
Tip: Non-public facing apps are now OK. As the 2019 novel coronavirus (COVID-19) continue... Read more
Medicare Advantage:
Register These 2021 Medicare Advantage and Part D Proposals
Hint: CMS continues to push telehealth services. With pandemic worries dominating the new... Read more
Industry Note:
See How 1135 Waivers Impact Medicare Enrollment in New FAQ
With the healthcare industry besieged by the 2019 novel coronavirus (COVID-19), the feds h... Read more
Industry Note:
Feds Approve 34 States' Waivers — and Counting
If you care for Medicaid beneficiaries in your state, the feds have some good news in thes... Read more
Industry Note:
Beware of COVID-19 Scammers, Warns OIG
Even during a crisis of epic proportions like the 2019 novel coronavirus (COVID-19), you m... Read more
Reader Question:
Verify MBI Status If Problems Arise
Question: A few of our Medicare patients' claims have been rejected, despite using their M... Read more
Covid-19 Update:
Review Medicare's Telehealth Expansion Details
The 1135 waiver offers temporary relief for providers. As providers across the nation at... Read more
Knows These Telehealth Waiver Fundamentals
Register the top 5 must-knows about the Medicare updates. Medicare's expansion of teleh... Read more
Medicare Advantage:
Pocket 6 Expert Facts on Medicare Advantage Plans
Know that coverage rules differ significantly from Part B guidelines. If it feels like yo... Read more
Practice Management:
Apply Local Insight to Manage Practice During an Outbreak
Tip: Update decontamination policies accordingly. The decisions you make on a daily basis... Read more
Clip and Save:
Manage Your Mobile Device With 5 Steps
Tip: Set realistic BYOD rules. Mobile devices encourage coordination among providers, mak... Read more
Reader Question:
Know These Coding Options for COVID-19 Quandaries
Question: Has the government issued any guidance regarding coding for the current coronavi... Read more
Industry Notes:
CMS Releases New PACE Guidance in Response to COVID-19
Plus: Push back non-essential care for beneficiaries, feds suggest. The 2019 novel corona... Read more
Reimbursement:
Know the Hospital-Based Price Transparency Rule Facts
Tip: Choose your additional 230 shoppable services wisely. With Medicare rules seemingly ... Read more
Review 5 Steps to Prepare for Hospital-Based Price Transparency Requirements
Tip: Coordinate across departments for informed decision making. Time flies when you're c... Read more
Revenue Booster:
Master the Fee Schedule With These 8 Facts
Tip: Take advantage of the searchable database. From coverage rules to payment amounts, s... Read more
Health IT:
Increase Your AI Knowledge in 2020
Pocket 7 must-know terms and boost your AI savvy. As a Medicare provider, you may be util... Read more
Industry Note:
Medicare Budget Cuts Loom Large in 2021
It looks like Medicare providers may be tightening their belts again for 2021. Why? On Fe... Read more
Industry Note:
Feds Extend Joint Replacement Bundling Demo for 3 More Years
If you were looking forward to the end of the Comprehensive Care for Joint Replacement (CJ... Read more
Industry Note:
Submit MIPS 2019 Data ASAP
If you're struggling to send your 2019 Merit-Based Incentive Payment System (MIPS)... Read more
Industry Note:
CDC Updates With Advice to Protect Providers from Infection
The Centers for Disease Control & Prevention (CDC) advises the healthcare industry to ... Read more
Reader Question:
See New Vaping-Related Disorder Code Available April 1
Question: Our practice sees more and more patients with health issues related to vapi... Read more
Novel Coronavirus Round-Up:
Feds Offer Plethora of Guidance to Combat Novel Coronavirus
CMS updates with new HCPCS code. As worries about the novel coronavirus 2019 (COVID-19) p... Read more
Privacy:
Know These PHI Disclosure Essentials
Hint: Review your state's privacy rule under a PHE. As the novel coronavirus (COVID-19) c... Read more
Compliance:
Cut Audit Odds With This Expert Advice
Hint: Watch for number transposition with common codes. As the Centers for Medicare &... Read more
HIPAA:
Court Decision on Right of Access Creates Confusion
Tip: Check your state rules on data sharing. There's no doubt that the feds' mixed messag... Read more
See 4 Tips to Address Right of Access Woes
The government usually updates HIPAA to clarify rules and add protection for patients, but... Read more
Industry Notes:
Utilize Updated MIPS Tool to Chart 2020 Measures
Plus: Use revised CMS-855R form starting May 1. It's likely crunch time at your practice ... Read more
Enforcement:
Healthcare Fraud Recoveries Exceed $2 Billion in 2019
Hint: Expect healthcare to remain a primary target in 2020. Though the feds may be keen t... Read more
Compliance:
Protect Your Practice Against Whistleblowers
Tip: Take all employees' concerns into account. If you feel overwhelmed by Medicare's ste... Read more
Address Qui Tam Concerns With These 4 Tips
Hint: Educate staff on compliance to circumvent fraud. Being at the center of a qui tam s... Read more
National Correct Coding Initiative:
Take a Closer Look at the NCCI PTP Edit Pair Guidelines
Know how 0, 1, and 9 add up to total coding success. You may be struggling to interpret t... Read more
Policy Update:
Know All the Facts on New Acupuncture Coverage Changes
Caution: Review provider restrictions to avoid denials. If acupuncture services are on yo... Read more
Reimbursement:
Screen Your Third-Party Billers
Tip: Ask to see second references. Are you considering updating your billing protocols or... Read more
Industry Notes:
QPP Results Show Incentives on the Rise
Plus: CMS says MIPS participation is up, too. Many providers found the 2017 Quality Payme... Read more
Recovery Audit Contractors:
Expect Heightened Scrutiny on AWV and IPPE Blunders in 2020
All 3 RACs spotlight this perennial Medicare problem. Annual wellness visits (AWVs) and i... Read more
Telehealth Compliance:
Bolster Telehealth Reporting With MAC Reps' Insight
Hint: Location factors into Medicare's conditions for payment. As Medicare and other paye... Read more
Compliance:
Prep Your Staff for Disaster With These Tips
Reminder: CR modifier isn't just for natural disasters. The earthquakes in Puerto Rico ar... Read more
Quality Payment Program:
Know These MIPS Eligibility Essentials
Plus: Find out how MIPS exemption works. Medicare is knee-deep in its fourth year of the ... Read more
Reader Question:
Practice Scope Determines Risk Documentation
Question: We are in the beginning stages of our annual risk assessment. Is there a format ... Read more
Industry Notes:
Use MBI Tool to Review Deceased Patients' Information
Date of death factors into MBI accessibility. You can still pull up a patient's Medicare ... Read more
Coding Errors:
Documentation Struggles Top CERT Report
‘Corrective actions' factor in 2019 improper payment rate reductions. You may find Medi... Read more
Expect More Payment Scrutiny in the Future
New ‘five-pillar' program aims to cut the rates upfront. Due in part to the skyrocketin... Read more
Compliance:
E/M Services Remain Perennial Problems for Providers
Initial hospital care, office visits top improper payment charts. It's no surprise that p... Read more
Quality Payment Program:
Review 3 New QPP Updates
The feds need QPs' information ASAP. Quality reporting is tricky, and the policies change... Read more
Toolkit:
Add These 10 Coding Tips to Your 2020 Policies
Hint: Know your MAC's rules to avoid confusion. Collecting Medicare reimbursement for all... Read more
Industry Notes:
FDA Gets New Commissioner
Plus: Sidestep Medicare exclusion with new tutorial. After months with an array of acting... Read more
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