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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 15
MPFS:
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Servic...
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Reimbursement:
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim t...
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Documentation:
Address These Key Fields, Complete ABNs With Ease
Don't forget that every ABN form must be one single page. As every practice is aware, co...
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News You Can Use:
Find Out What RCM Staff Learned From the Change Healthcare Outage
Learn how long paper-based claims take to process. When cyberthreat actors deployed a ra...
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Reader Questions:
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says we...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 14
ICD-10 2025:
Know What 2025 Has in Store for Oncology ICD-10 Coding
And know why the changes are going to matter for Medicare billing. On October 1, 2024, th...
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Compliance:
Prepare for Proper Preventive Service Coding
Review the requirements of MWVs and AWVs. Regular checkups for patients is a given in an...
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Best Practices:
Dissect Your Workflow to Streamline Operations
Hint: Patient satisfaction is all about setting expectations. In a medical practice, or...
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ICD-10 2025:
Codes for Epilepsy, Disc Degeneration Highlight New Additions
Do you know what KCNQ2-related epilepsy is? ICD-10 just settled on its list of new, revis...
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Reader Questions:
Patients May Need to Choose Between Benefit Programs
Question: One of our patients mentioned to a nurse that they were receiving continuin...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 13
Fraud & Abuse:
Feds Focus On Physicians In June Enforcement
Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have n...
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Health IT:
Final Rule Outlines Info Blocking Disincentives For Quality Programs
Reg thwarts information blocking among MIPS clinicians, ACOs, and PI programs. No matter...
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Reimbursement:
Try These Tips For Boosting Financial Literacy
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ens...
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Part B Coding Coach:
Pocket 3 Handy Q&As; On Allergy Testing Coding
See how to report and bill different supply scenarios. Green grass, blossoming trees, an...
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Reader Questions:
Know The Facts About Disclaimers On Records
Question: One of the physicians at our practice uses dictation software, and the vend...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 12
Enforcement:
OIG Maintains Spotlight On Managed Care Mayhem
Latest report has a new look and offers insight into the agency's top targets. Since 2022...
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Practice Safety:
Keep Your Staff, Patients Safe With These Lab Precautions
Hint: Follow OSHA, but also have policies in place customized to your practice. Every la...
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Part B Coding Coach:
Unravel Place of Service, Site and Level of Care
Get expert guidance on avoiding denials. Keeping up with all the different ways to deal ...
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Reader Questions:
Heed This Insight On Documentation Requests For CERT Reviews
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi...
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Reader Questions:
Know The Facts On How MedPAC Impacts Your Bottom Line
Question: I've seen a lot of “MedPAC says this” and “MedPAC says that,” but I...
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Reader Questions:
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber Ans...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 11
Targeted Probe And Educate:
Establish Practice Protocols For Addressing A TPE Audit
Hint: Look at your MAC's focus to troubleshoot internal issues. Whether you've already s...
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EMTALA Update:
Find Out The Latest On New EMTALA Violation Complaint Option
Feds continue to protect patients' access to emergency care. With EMTALA violations on th...
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MIPS Quiz:
Test Yourself On The APM Performance Pathway
Understand what makes a provider a QP. Since CMS launched the Quality Payment Program (Q...
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Part B Coding Coach:
Know the Flow of Urodynamic Test Coding
Dodge claim errors by spotting the differences between these tests. When a provider cond...
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Reader Questions:
Focus On The Facts When Hiring HIPAA Audit Assistance
Question: Our large, primary care practice takes HIPAA very seriously, and we do our ...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 10
Medicare Advantage:
New Rule Circumvents Beneficiary Data Sharing
Feds also aim to rein in brokers' avarice. With rising concerns that third-party brokers...
Read more
MIPS Quiz:
Estimate Your MVP Prowess With This Test
Know the facts on submitting MVPs and Traditional MIPS simultaneously. Since reporting b...
Read more
Part B Coding Coach:
Avoid These 5 Modifier 59 Errors To Keep Pay Flowing
Plus: Find out the 2024 news that changes one modifier 59 rule. What would you do if 40 ...
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Toolkit:
To Notify Or Not To Notify — That Is The Question
Follow this decision tree to determine breach reporting. Practices often struggle with ...
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Industry Notes:
QPP 2024 Hardship Applications Are Now Open
If you're struggling with meeting the demands of the Quality Payment Program (QPP), you ma...
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Industry Notes:
The Pre-Presidential Election Rule Rush Is In Full Flow
If you feel like federal regulations are raining down like never before, you're probably r...
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Reader Questions:
Know What Traditional Medicare Won’t Pay Extra For
Question: I thought Medicare does not pay extra for physical status modifiers or qual...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 9
HIPAA:
New Rule Aims To Bolster Confidentiality Post-Dobbs
OCR adds updates that support privacy in reproductive healthcare. As legal wrangling cont...
Read more
MIPS Quiz:
Assess Your Command Of The Quality Performance Category
Figure out what the data threshold is for PY 2024. The key to avoiding penalties and max...
Read more
Part B Coding Coach:
Use These 6 Tips To Code Hearing Tests Successfully
Start by knowing what's included in an E/M visit. If your practice includes an audiologi...
Read more
Industry Notes:
UnitedHealth-Change Healthcare Cyberattack Damage Continues, Even After Ransom Was Paid
If you were wondering whether UnitedHealth Group (UHG) paid the hackers who attacked its ...
Read more
Industry Notes:
OCR Adds FAQs On Change Healthcare Incident
As the ransomware incident that clocked UnitedHealth Group's subsidiary Change Healthcare ...
Read more
Industry Notes:
OIG Report Points Out PRF Overpayment Issue … Again
If you thought the HHS Office of Inspector General's (OIG) scrutiny of CARES Act Provider...
Read more
Reader Question:
Understand These NPI Basics For New Providers
Question: Our practice just hired a new provider. They have their medical license, bu...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 8
Payment Models:
CMS Continues To Focus On Quality And Savings
Recent payment models offer primary care, behavioral health expanded options. Not only d...
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MIPS Quiz:
Gauge Your Promoting Interoperability Savvy
Hint: Know the 4 PI objectives for PY 2024. If you think the Promoting Interoperability...
Read more
Part B Coding Coach:
+99459: 5 FAQs Clarify How to Use This Expense Only Code
Here's what your physician's documentation needs to include. Since January 1, you can us...
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Clip and Save:
Pocket This Primer On Informed Consent Forms
Pocket This Primer On Informed Consent Forms Critical: CMS revises interpretive guidance ...
Read more
Reader Questions:
Understand The Rules On Reinstatement After Exclusion
Question: When an individual is excluded from participating in the Medicare program b...
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Reader Questions:
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures...
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Reader Questions:
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 7
Budget:
Find Out Top Factors In FY 2025 Budget Proposals
Funding for oversight and fraud enforcement are among the top budget requests. With 2024...
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Feds Finalize 2024 Funding
Tip: Understand these conversion factor changes already in effect. The feds finalized not...
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MIPS Quiz:
Evaluate How Well You Know The MIPS Improvement Activities
Tip: Understand what you need to get full credit in this performance category. For many...
Read more
Part B Coding Coach:
Make Radiation Treatment Management Codes Count
But use this one code sparingly, if ever. There are many moving parts to radiation treatm...
Read more
Industry Notes:
Feds Offer Tools For Providers Affected By Cyberattack
If your practice is one of the many affected by the cyberattack against Change Healthcare...
Read more
Reader Questions:
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely...
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Reader Questions:
Make Sure Your Health Apps And Wearables Are Compliant
Question: We use wearable devices and health apps to remotely monitor our patients wh...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 6
Cybersecurity:
CMS Offers Support Amidst Change Healthcare Attack
Crucial: Connect with your MAC and other payers for additional advice. If you're scrambl...
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HIPAA:
OCR Warns Entities About Prioritizing Cybersecurity
Key stakeholders met to discuss ‘interconnectedness' of U.S. healthcare system. With r...
Read more
MIPS Quiz:
Measure Your Cost Category Knowledge
Tip: Understand there's more than one type of measure in Cost. Mastering the Merit-Base...
Read more
Part B Coding Coach:
Debunk These 3 Common Allergy Coding Myths
Remember to report the cause of asthma exacerbation. With allergy season in full swing, y...
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Pocket This ICD-10-CM Update For Asthma Coding
Changes are effective starting April 1. This past January, the Centers for Disease Contro...
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Industry Notes:
Review MAC Guidance Before Sending That AAP Request
If you plan on applying for the Change Healthcare/ Optum Payment Disruption (CHOPD) accele...
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Industry Notes:
CMS Reopens 2023 MIPS EUC Application
If you've been impacted by the Change Healthcare cyberattack and you can prove it's affect...
Read more
Medicare Compliance & Reimbursement - 2024; Volume 50, Number 5
Prior Authorization:
Final Rule Aims To Improve Interoperability And Access To Care
Plus: Feds finalize new API requirements and a MIPS measure, too. After the pandemic reve...
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Fraud & Abuse:
Feds Focus On Physicians In February Enforcement
Caution: The 2023 FCA settlement numbers may shock you. Per usual, the feds are off and r...
Read more
MIPS Quiz:
Test Your MIPS Smarts With This Quiz On The Basics
Tip: Know what your participation options include. Even though the Quality Payment Progr...
Read more
Part B Coding Coach:
Tackle Thyroid Procedure Coding With These Tips
Check provider's wording to ensure understanding and claims success. When coding thyroid...
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Industry Notes:
Ensure Your Team Knows The Rules On Recoupment
Keep staff in the loop to avoid issues. Educating your personnel on how recoupment reques...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 4
HIPAA Round-Up:
Feds Follow Through With Final SUD Rule
Plus: See the latest settlement and regulatory updates. Even though we're only a few mon...
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Artificial Intelligence:
Discover How CMS Is Harnessing AI
Check out the agency's AI Playbook and what's ahead with emerging tech. As AI evolves and...
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Expect AI To Be An Enforcement Tool — And Target
Experts warn about the perils of too much dependency on AI. You may find that the pros ou...
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Part B Coding Coach:
Strengthen Your Modifier QW Savvy With These Steps
Don't forget to check the CLIA list when submitting a new lab test — every time. Whil...
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Reader Question:
Understand These CMN Basics
Question: My billing supervisor erased data that the doctor wrote on a certificate of...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 3
No Surprises Act:
Feds’ Balance Billing Opus Continues To Evolve
Lawsuits, fee changes, and proposals abound. Since its inception, turmoil has surrounded ...
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EMTALA:
Feds Offer Clarity On Providers’ Obligations Under EMTALA
Patient inquiries cause HHS and CMS to offer public education resources. As the courts co...
Read more
Part B Coding Coach:
Bolster Colonoscopy Pre-Op Smarts With These Tips
Hint: Don't forget how comorbid conditions can impact pre-op E/M coding. Whether you're ...
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Industry Notes:
Review Which Codes Require Invoices, MAC Warns
Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) remin...
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Industry Notes:
Compare Site Now Includes Physicians’ And Clinicians’ Procedure Volume Data
If you want to find utilization data on the number of procedures clinicians and physicians...
Read more
Reader Questions:
Know the Difference Between EMRs and EHRs
Question: I've seen the acronyms EMR and EHR used interchangeably, but our IT manager...
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Reader Questions:
Consider This Insight On Qualifying for Home Visit
Question: One of the providers at our practice wants to bill 99350 when performing a ...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 2
Medicare Advantage:
Bolster Managed Care Smarts With This Insight
Caution: Fix MA faux pas before OIG intervenes. With managed care on the HHS Office of I...
Read more
Part B Coding Coach:
Pocket This Assistant At Surgery Modifier Primer
Hint: Do not report modifiers 80 and AS together. An assistant surgeon may be necessary...
Read more
Health IT:
Know The 10 Agencies That Impact Your Health IT
Get the scoop from transactions to privacy to enforcement. One thing is certain in feder...
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Industry Notes:
See The Latest Provider Enrollment Fee Increase
It's time to tighten your belt again. The costs of Medicare provider enrollment went up fo...
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Industry Notes:
Submit PRF Attestations For RP 6 ASAP
If you received COVID-19 Provider Relief Fund (PRF) payments in the last half of 2022, the...
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Industry Notes:
Add These QPP Policy Deadlines To Your Calendar
If you want to offer your two cents on specific Quality Payment Program (QPP) policies for...
Read more
Reader Question:
Get The Facts On EHR Standards For MIPS 2024
Question: We're a little confused by the updated information on EHR requirements for ...
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Reader Questions:
Understand How The Part D Appeals Process Works
Question: As a Medicare Part D provider prescriber, our practice was curious about t...
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Medicare Compliance & Reimbursement - 2024; Volume 50, Number 1
Compliance:
CMS Reports Slight Error Rate Decrease For 2023
Documentation and medical necessity challenges top list of CERT woes. The feds made some ...
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Utilize This Handy CERT Tool
If you're stumped by CERT updates and are searching for all the latest and greatest on the...
Read more
Here’s Why You Should Care About The CERT Report
Tip: Compare and contrast your internal issues against the national averages. Even if y...
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CERT Quiz:
Test Your Smarts On MACs’ Role In CERT Review Process
Hint: It's complicated. As a Medicare provider, you may be accustomed to checking with th...
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Part B Coding Coach:
Follow 3 Steps To Bolster Bleeding Control Reporting
Hint: Don't forget to review NCCI policies. During a surgical procedure or in the midst o...
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Industry Notes:
OCR Settles First Phishing Case
Caution: Analyze your risks, or pay the price. The benefits of technology to healthcare...
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