Case management is a tactical and strategic profession governed by ever-changing regulations. Staying current with regulations is not something a case management leader can do casually or occasionally. The process requires thoughtfulness, broad thinking, and the ability to educate staff and to implement and audit process changes as they relate to new regulations.
This week’s Medicare updates include the release of the Medicare Physician Fee Schedule proposed rule, a fact sheet regarding proposals for the Quality Payment Program in 2019, the End-Stage Renal Disease and Durable Medical Equipment proposed rule, and more!
CMS recently released new documentation guidance on medical review of E/M services performed by medical students. A medical student may document E/M services if the physician performs or re-performs the exam and then verifies the student’s documentation.
CMS began rolling out new cards to Medicare beneficiaries in April and recently announced that wave one of the mailing has been completed. The new cards are intended to help protect beneficiaries’ Social Security Numbers.
The HIPAA Security Rule requires information systems activity review, but a number of covered entities and business associates have yet to implement a robust security program that includes monitoring audit logs. Per the preamble to the Omnibus Rule, if audit logs are generated and you’re not looking at them periodically, that could be considered willful neglect.
CMS had a 71.3% improper payment rate for surgical dressings in 2017, accounting for 0.3% of the overall Medicare Fee-for-Service improper payment rate that year, according a Comprehensive Error Rate Test (CERT) report in the most recent Medicare Quarterly Provider Compliance Newsletter.