MALIGNANT BREAST DISORDERS WITH CC DRG Code 598

It’s not your imagination if you’re feeling the heat of federal scrutiny. Last year the feds settled violations related to the healthcare industry at upwards of $5 billion — and a good chunk of that was due to whistleblowers. The [...]

It’s not your imagination if you’re feeling the heat of federal scrutiny. Last year the feds settled violations related to the healthcare industry at upwards of $5 billion — and a good chunk of that was due to whistleblowers. The [...]

Hint: Suggested E/M documentation changes could balance shortcomings. If a hefty portion of your Part B take-home pay is tied to E/M office visits, you may want to review recent Medicare proposals. However, depending on your specialty and the number [...]

Hint: Suggested E/M documentation changes could balance shortcomings. If a big part of your Medicare pay is tied to evaluation and management (E/M) office visits, you may be concerned about recent proposals from CMS. But depending on your specialty and [...]

Therapy episodes would get reimbursed less. If your claims are dominated by episodes with high therapy, no recent hospital stays, or patients with behavioral health conditions such as schizophrenia, bipolar disorder or drug addiction, Medicare’s draft for HH PPS payment [...]

Plus: Infection and inflammatory reaction choices have numerous changes. With the first official round of ICD-10 updates going into effect on Oct. 1, it’s crucial to spend the next two months preparing for the changes that will affect your practice [...]

SMART FACTS replaced with SIRS. The Centers for Medicare & Medicaid Services (CMS) has an able partner in its fight against fraud and abuse — the Senior Medicare Patrol (SMP). These volunteers are vigilant about uncovering Medicare and Medicaid abuse [...]

The Senior Medicare Patrol continues to make strides and recoveries. Since its formation in 1997, the Senior Medicare Patrol (SMP) has been a boon to CMS with recoveries totaling over $117.6 million. The SMP volunteers, made up of retirees and [...]

Texas HHA exec receives 10-year sentence. Physicians furnishing a large volume of home care certifications — and the home health agencies who receive referrals and certs from them — are under the microscope, some recent fraud cases illustrate. Case #1: [...]

If you’re planning to bill Medicare for visits with patients, ensure that you actually perform the visit first. That’s the word from a recent Department of Justice (DOJ) case involving a New Jersey family physician. The doctor plead guilty this [...]