Plus: One state claimed more than $50 million in unallowable PCA services, OIG report charges. Both federal and state authorities are getting ever-more-serious about combatting fraud in Medicaid home health programs, as shown by a flurry of enforcement activity in [...]
Question: Can a provider bill a separate evaluation and management (E/M) service for confirmation of pregnancy, or is it considered to be initial OB? Patient saw her primary care physician (PCP) via telemedicine prior who diagnosed amenorrhea with positive home pregnancy [...]
Don’t be surprised at how CMS and MedPAC use your hourly wage data. You’d better take your cost reporting duties seriously under the newly released home health cost report form, or face likely reduced reimbursement rates in the future. Learn [...]
Read the medical note and determine which codes you would report. Sometimes it can be challenging to determine the right codes for an inpatient encounter unless you have all of the documentation in front of you. This month, we’re challenging [...]
Final rule follows through on proposed increases to GIP, CHC, and IRC. Providers that mostly furnish Routine Home Care or GIP in other facilities are getting the bad end of the deal in Medicare’s payment rebalancing between care levels. Why? [...]
Which category will you fall into? As of Oct. 1, Medicare will pay significantly more for advanced levels of care and less for Routine Home Care days — and that may drastically change the financial picture for the majority of [...]
Don’t forget: Your reimbursement rates depend on cost report data. If you are looking at who is to blame for a de facto rate cut from Medicare next year, you might want to start by looking at your own cost [...]
OIG auditors seize on physician narrative. Are you prepared for the HHS Office of Inspector General to present you with a $7.5 million bill if your claims don’t stand up to scrutiny? That’s what is happening to one New York [...]
Reg can result in de facto exclusions. Get ready to lay out major time and money to comply with Medicare’s latest proposal for enrolment and reenrollment. The Centers for Medicare & Medicaid Services wants providers to drastically increase items they [...]
The HHS Office for Civil Rights (OCR) closed out 2015 with a booming December for healthcare breaches, logging 23 reported breach incidents. Of the 23 total, most involved healthcare providers (19) with four affecting health plans. Twelve breaches involved unauthorized [...]
