This week's note from the instructor is the first article in a series reviewing the coverage, billing, and payment rules for swing bed services. This edition of the series focuses on the definition of swing bed services and general requirements hospitals must meet to provide covered swing bed services.
This week’s Medicare updates include a list of new topics proposed for recovery audit review, a final decision memo for an NCD on MRI coverage, notice of the new interest rate for overpayments and underpayments, and more!
This week's note from the instructor highlights billing and coding regulations for specimen validity tests billed in combination with urine drug tests in the wake of an OIG audit which found a 99% error rate for these claims.
This week’s Medicare updates include a final rule on various policies throughout the Medicare program involving drug pricing, the final 2019 Medicare Advantage rate announcement and call letter, a list of newly added waived test codes, and more!
This week’s Medicare updates include two new fact sheets on Merit-based Incentive Payment System (MIPS) policies, a Special Edition MLN Matters article on proper coding for certain laboratory tests, instructions regarding the new skilled nursing facility Advance Beneficiary Notice (ABN) forms; and more!
This week’s Medicare updates include several corrections to transmittals issued regarding April 2018 payment system updates, four new resources for those participating in the Quality Payment Program via an alternative payment model, an OIG review of outpatient physical therapy billing, and more!
This week’s Medicare updates include a special edition MLN Matters article on billing requirements for OPPS providers, an updated OIG work plan, a final decision memo for an NCD on genetic testing for cancer patients, and more!
This week’s Medicare updates include the April 2018 quarterly update files for drug pricing, DMEPOS, and ambulatory surgical centers; a prolonged comment period for an NCA on a type of cancer treatment; an announcement of a new technological initiative for Medicare beneficiaries; and more!
This week’s Medicare updates include an advisory opinion on whether an excluded individual could be employed by an entity involved in federal healthcare programs; a pair of fact sheets on the cost and advancing care information performance category policies for MIPS in 2018; a video for medical offices on the new Medicare cards; and more!
This week's note explains and defines various policies enacted by the Bipartisan Budget Act of 2018, including policies related to outpatient therapy caps and the use of modifier -KX; the low-volume hospital adjustment; the Medicare dependent hospital program; and more. Updated March 2, 2018 for clarity on therapy cap exclusions.
This week’s Medicare updates include two compliance reviews from the Office of Inspector General, an enforcement instruction on supervision requirements for outpatient therapy, clarification of instructions for medical reviews of inpatient rehabilitation facility claims, and more!
This week’s Medicare updates include a list of new topics proposed for recovery audit contractor review, a final decision memo on a cardiology device NCD, a diagnosis code update for add-on payments for a blood clotting factor, and more!
This week’s note explores the newly expanded national targeted probe and educate initiative with a focus on how processes for the program should work and what providers can do to simplify the review period.
This week’s Medicare updates include a fact sheet on the transition to new Medicare cards, a table to clarify alternative payment models’ statuses in the Quality Payment Program, a review of a health system’s compliance with inpatient rehabilitation facility service billing requirements, and more!
This week’s Medicare updates include new skilled nursing facility advance beneficiary notice forms, the 2019 Advanced Notice for Medicare Advantage and Part D plan changes, quarterly HCPCS drug/biological code changes, and more!
This week’s Medicare updates include a notice about the therapy caps exceptions process expiration, two fact sheets regarding the advanced alternative payment model determination process, revisions to guidance for rural health clinic surveyors, and more!
This week’s Medicare updates include the announcement of a new bundled payment model, clarification on CMS’ regulations regarding texting of patient information, notification of the new interest rate for overpayments and underpayments, and more!
This week’s Medicare updates include an advisory opinion on sharing cost savings created by cost-reduction measures, a correction to the Medicare provider enrollment application fee, a new data submission system for the Quality Payment Program, and more!
This week's note reviews guidance from CMS on how to report the new 340B modifiers and discusses how hospitals can create systems and processes to ease implementation of new billing requirements associated with the 340B changes.
This week’s Medicare updates include corrections to the OPPS final rule, clarification of Medicare’s policy regarding texting of patient information between healthcare providers, revisions to rural health clinic guidance, and more!
This week’s Medicare updates include a fact sheet on the 2018 EHR Incentive Program payment adjustment; transmittals regarding the January 2018 updates to the OPPS, ambulatory surgery center payment system, and physician fee schedule; a memo detailing three categories of sanctions for proficiency testing referrals; and more!
This week’s Medicare updates include two new advisory opinions; updates to the Physician Compare, Long-Term Care Hospital Compare, and Inpatient Rehabilitation Facility Compare websites; a republished version of the OPPS final rule to include a previously omitted section, and more!
This week’s Medicare updates include an extension for S-10 worksheet submission, implementation plans for computed radiography payment reductions, a new national coverage article for a genetic sequencing diagnostic test for cancer patients, and more!
This week’s Medicare updates include the announcement of the Part A and Part B premiums and deductibles for 2018, clarification on new Conditions of Participation regarding home health agency subunits, a proposed decision memo on conditions of coverage for implantable cardioverter defibrillators, and more!
This week’s Medicare updates include an advisory opinion on using network hospitals for inpatient stays; annual updates to HCPCS codes used for home health consolidated billing and the therapy code list; the removal of hyperbaric oxygen therapy (topical application of oxygen) from an NCD; and more!
This week’s Medicare updates include new hospital appeals settlement options, revisions involving the addition and deletion of ICD-10-CM codes from certain NCDs, details on the partial settlement of a 2-Midnight policy court case, and more!
This week's note reviews two major policy changes from the OPPS and MPFS final rules: the reduction in reimbursement for 340B drugs and the reduction in the payment adjustment for non-excepted off-campus provider-based departments.
This week’s Medicare updates include the OPPS, Quality Payment Program, End-Stage Renal Disease, and Medicare Physician Fee Schedule final rules; an announcement of the new Meaningful Measures initiative; a list of new Clinical Laboratory Improvement Amendments waived tests; and more!
This week's note reviews pre-service coverage analysis processes in light of the recent CMS decision to delegate the target, probe, and educate medical review strategy to the Medicare Administrative Contractors.
This week’s Medicare updates include the quarterly listing of program issuances, a fact sheet on the federal health exchange’s 2018 open enrollment period, revised instructions for certificate of medical necessity and durable medical equipment information forms, and more!
This week’s Medicare updates include additional government guidance on wildfires and hurricanes, modifications to proof of delivery requirements, clarification on billing of immunosuppressive drugs, and more!
This week’s Medicare updates include notification of a new interest rate for Medicare Overpayments and Underpayments, revisions to the Medicare Claims Processing Manual regarding payment of services furnished by qualified nonphysician anesthetists, a fact sheet for hospitals on the 2018 Medicare EHR Incentive Program payment adjustment, and more!
This week’s Medicare updates include corrections to the IPPS final rule; corrections to the Skilled Nursing Facilities Prospective Payment System final rule; year 3 baseline data on Medicare payments for clinical diagnostic laboratory tests; and more!
This week’s Medicare updates include clarification on portable x-ray necessity, recommendations from the hospital outpatient payment advisory panel, an adjustment to the amount in controversy threshold amounts for 2018, and more!
This week’s Medicare updates include an OPPS update; guidance on coding and billing date of service on professional claims; CMS’ efforts to support Puerto Rico and the U.S. Virgin Islands in the wake of Hurricane Maria; and more!
This week’s Medicare updates include information on submitting claims to Medicare for beneficiaries in Florida affected by Hurricane Irma; annual HCPCS updates for SNFs; FY 2018 IPPS and LTCH PPS updates; and more!
This week’s Medicare updates include an update to the Ambulatory Surgical Center Payment System; revisions to the State Operations Manual; information on CMS approval of CHIP provisions to assist with Hurricane Harvey disaster relief; and more!
This week's Medicare updates include a new OIG advisory opinion; the October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS); the Inpatient Rehabilitation Facility (IRF) Annual Update; and more!
On August 14, CMS published the FY2018 Inpatient Prospective Payment System Final Rule; with it came discussion and a notice in regards to the 96-hour certification requirement for critical access hospitals (CAH).
This week's Medicare updates include the 2018 Inpatient Psychiatric Facilities Prospective Payment System Update; Revisions to the Home Health Pricer to Support Value-Based Purchasing and Payment Standardization; Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS); and more!
This week's Medicare updates include an update to the Revisions to the Inpatient Prospective Payment System; Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF) for 2018; Provider-Based (PB) Determination; and more!
This week's Medicare updates include an update to the 2018 Proposed Home Health Prospective Payment System Rate; ICD-10 Coding Revisions to National Coverage Determinations; Updated Editing of Always Therapy Services; and more!
This week's Medicare updates include the Medicare Claims Processing Manual Chapter 15 Update; the Assistant Inspector General for Evaluation and Inspections Office testifies before congress; revision of the Quality Improvement Organization (QIO) Manual; and more!
This week's Medicare updates include the 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule; the 2018 Medicare Physician Fee Schedule (MPFS) and Other Revisions to Part B / the Medicare Shared Savings Program Requirements and Medicare Diabetes Prevention Program proposed rule; the Federal Healthcare Fraud Takedown; and more!
This week's Medicare updates include a revision to State of Operations Manual (SOM) Appendix PP for phase 2; suppression of G9678 Oncology care model monthly enhanced Oncology services; an OIG report on Part D plans; and more!
This week's Medicare updates include phase 2 of implementing FISS updates to accommodate section 603 of the Bipartisan Budget Act of 2015; new effective dates for Hepatitis B Virus screening programs; revisions to the End-Stage Renal Disease Prospective Payment System 2018 Proposed Rule; and more!
This week's Medicare updates include a Quality Payment Program proposed rule; new guidance for formatting plans of correction; clarification regarding Conditions for Coverage for End Stage Renal Disease facilities; and more!
This week’s Medicare updates include the elimination of routine reviews including documentation compliance reviews and instituting three medical reviews; new guidance for outpatient facility claims; standardization of demand letter language; and more!
This week’s Medicare updates include the July 2017 update to the Ambulatory Surgical Center Payment System; the Spring 2017 Semiannual Report to Congress; a new Targeted Probe and Educate Pilot; and more!
This week’s Medicare updates include National Coverage Analysis for Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease; ICD-10 coding revisions to National Coverage Determinations; the July 2017 OPPS quarterly update; and more!
This week's note discusses the order and certification requirement for critical access hospitals (CAH), including the proposal in the FY 2018 IPPS proposed rule to reprioritize the review of CAH inpatient admissions.
This week’s Medicare updates include a clarification of medical reviews of hospital claims for Part A payment, two new “K” codes for therapeutic continuous glucose monitors, The July 2017 quarterly HCPCS Drug/Biologicals code change update; and more!
This week’s Medicare updates include new CLIA waved tests, changes to the payment policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly “Locum Tenens Arrangements”), implementation of modifier -CG for Type of Bill 72x, and more!
This week’s Medicare updates include the April 2017 Medicare Quarterly Provider Compliance Newsletter, scribe services signature requirements, outlier limitation on OPPS Community Mental Health Centers Services, and more!
This week’s Medicare updates includes new information on payment for moderate sedation services, influenza virus vaccine code implementation, new K codes for therapeutic continuous glucose monitors, and more!