June 22, 2017
Medicare Insider

This week's note discusses the Social Security Number Removal Initiative, or SSNRI. 

June 21, 2017
Medicare Insider

This week's Medicare updates include OIG Work Plan updates; the annual ICD-10-CM code update; new information on how providers can to get ready for new Medicare Cards; and more!

June 14, 2017
Medicare Insider

This week's note discusses Medicare benefits for inpatient hospital coverage and Medicare as a secondary payer.

June 14, 2017
Medicare Insider

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!

June 7, 2017
Medicare Insider

This week's note from the instructor discusses CMS’ new policy concerning prolonged drug and biological infusions using an external pump.

June 6, 2017
Medicare Insider

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!

May 31, 2017
Medicare Insider

This week's note discusses reimbursement for “nonexcepted” provider-based departments.

May 30, 2017
Medicare Insider

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!

May 24, 2017
Medicare Insider

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.

May 23, 2017
Medicare Insider

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!

May 17, 2017
Medicare Insider

This week's note from the instructor discusses some frequently asked questions and resources related to provider-based departments, including off-campus departments.

May 16, 2017
Medicare Insider

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!

May 11, 2017
Medicare Insider

This week's note discusses 2017 CPT® codes for moderate sedation.

May 8, 2017
Medicare Insider

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!

May 2, 2017
Medicare Insider

This week’s Medicare updates include a MIPS Participation Status Letter, FY 2018 proposed rules for skilled nursing facilities and inpatient rehabilitation facilities, and more!

May 2, 2017
Medicare Insider

This week's note discusses rural health clinic off-site services that are provided to swing bed patients.

April 26, 2017
Medicare Insider

This week's note from the instructor discusses the newly released 2018 IPPS proposed rule.

April 25, 2017
Medicare Insider

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!

April 18, 2017
Medicare Insider

This week's note discusses the recent HCCA-OIG Compliance Effectiveness Roundtable as well as the resulting new compliance resource guide for providers.

April 11, 2017
Medicare Insider

This week’s Medicare updates include the release of the 2017 Inpatient Pricer; a decision memo for Hyperbaric Oxygen Therapy; a delay of effective date for the Conditions of Participation for home health agencies; and more!

April 4, 2017
Medicare Insider

This week's note from the instructor discusses several changes regarding inpatient-only procedures that might have flown under the radar for some hospitals.

April 3, 2017
Medicare Insider

This week’s Medicare updates include an announcement regarding enforcement discretion on clinical laboratory data reporting; a new OIG resource guide for measuring compliance program effectiveness; a memorandum regarding the final rule adjusting Civil Monetary Penalties for inflation; and more!

March 28, 2017
Medicare Insider

This week's note from the instructor discusses new CMS guidance on inpatient orders and minor reference changes to CMS' patient-status guidance.

March 27, 2017
Medicare Insider

This week’s Medicare updates include additional information on denial of home health payments when required patient assessment is not received; Advanced Provider Screening phase 1 go-live; an MLN Matters article on billing for Advance Care Planning claims; and more!

March 21, 2017
Medicare Insider

This week's note from the instructor concludes our discussion on multiple notices that hospitals and critical access hospitals (CAH) are required to provide to outpatients and inpatients in particular situations. The focus this week will be on streamlining hospital notification processes to avoid the necessity of recreating the wheel each time a new notice requirement is implemented.

March 21, 2017
Medicare Insider

This week’s Medicare updates include an OIG report regarding hospital noncompliance with Medicare Requirements for billing outpatient right heart catheterizations with heart biopsies; a new educational initiative to raise awareness of chronic care management; quarterly updates to the ESRD PRICER; and more!

March 14, 2017
Medicare Insider

This week’s Medicare updates include an OIG Advisory Opinion; new MOON FAQs; a CMS transmittal clarifying admission order and medical review requirements; and more!

March 14, 2017
Medicare Insider

This week's note from the instructor continues last week's discussion regarding the multiple notices that hospitals and critical access hospitals are required to provide to outpatients and inpatients in particular situations.

March 9, 2017
Medicare Insider

No later than Wednesday of this week—March 8, 2017—hospitals (including critical access hospitals [CAH]) are required to meet the newest of Medicare’s numerous hospital notification requirements. Under the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, hospitals must provide both written and oral notice regarding the outpatient nature of observation and the resulting implications to all Medicare beneficiaries who receive observation services for more than 24 hours. This notice must be provided in a prescribed form  (the Medicare Outpatient Observation Notice [MOON]) within 36 hours of when observation care began and must meet certain additional requirements with respect to delivery, documentation, etc.

March 7, 2017
Medicare Insider

This week’s Medicare updates include the April 2017 Update of the Hospital Outpatient Prospective Payment System; the April 2017 Update of the Ambulatory Surgical Center Payment System; an National Coverage Analysis for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD); and more!

March 2, 2017
Medicare Insider

This week's note from the instructor discusses implementation of the Medicare Outpatient Observation Notice (MOON) and the implementation deadline, which is just a week away.

March 1, 2017
Medicare Insider

This week’s Medicare updates include a revision to State Operations Manual Appendix PP; ICD-10 Coding Revisions to NCDs, clarification of payment policy changes for Negative Pressure Wound Therapy using a disposable device and the outlier payment methodology for home health services; and more!

February 21, 2017
Medicare Insider

This week’s Medicare updates include the delay of the effective date of the Advancing Care Coordination Through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; a quarterly update to the Medicare Physician Fee Schedule database; ICD-10 coding revisions to National Coverage Determinations; and more!

February 21, 2017
Medicare Insider

This week's note is an excerpt from The Denials Management Training Handbook and discusses different types of claim denials.

February 13, 2017
Medicare Insider

This week's note from the instructor discusses the billing challenges presented by CMS' Medically Unlikely Edits.

February 13, 2017
Medicare Insider

This week’s Medicare updates include Advance Care Planning implementation for OPPS claims, revision to State Operations Manual Appendix PP - incorporating revised Requirements of Participation for Medicare and Medicaid certified nursing facilities, and more!

February 8, 2017
Medicare Insider

This week's note discusses the National Correct Coding Initiative (NCCI) Manual, an often overlooked source of guidance for coders and chargemaster professionals when determining correct coding and billing to Medicare.

February 7, 2017
Medicare Insider

This week’s Medicare updates include Medicare Outpatient Observation Notice (MOON) instructions, ICD-10 coding revisions to NCDs, a new “K” code for continuous positive airway pressure device bundle, and more!

February 1, 2017
Medicare Insider

This week's note from the instructor discusses changes to the Medicare Appeals Process as set forth in the final rule published January 17, 2017.

January 31, 2017
Medicare Insider

This week’s Medicare updates include a CMS Beneficiary Notices Initiative website update regarding the MOON form and instructions and more!

January 23, 2017
Medicare Insider

This week’s Medicare updates include additional guidance on the MOON form, an NCA for leadless pacemakers, delayed implementation of the (ESRD) Interim Final Rule – Third Party Payment, and more!

January 23, 2017
Medicare Insider

This week's note from the instructor discusses new guidance released by CMS regarding the Medicare Outpatient Observation Notice (MOON) form for hospitals and critical access hospitals.

January 18, 2017
Medicare Insider

This week’s Medicare updates include the latest Medicare Quarterly Provider Compliance Newsletter, a proposed decision memorandum for hyperbaric oxygen therapy NCA, new interest rates for Medicare overpayments and underpayments for Q2 2017, and more!

January 17, 2017
Medicare Insider

This week's note from the instructor discusses the future of Recovery Auditor reviews and the latest information from CMS as discussed during the recent Hospital Open Door Forum.

January 11, 2017
Medicare Insider

This week's note discusses important 2017 OPPS update transmittals and final rule corrections.

January 4, 2017
Medicare Insider

This week's note from the instructor reviews Medicare’s offset rules to drugs and biologicals.

January 4, 2017
Medicare Insider

This week’s Medicare updates include corrections to the OPPS, ESRD, and 2017 Physician Fee Schedule final rules, a renewal of the Advisory Panel on Hospital Outpatient Payment and Solicitation of Nominations to the Advisory Panel on Hospital Outpatient Payment, and more!

December 28, 2016
Medicare Insider

This week’s note discusses the main front-end, middle, and back-end revenue cycle functions.

December 28, 2016
Medicare Insider

This week’s Medicare updates include finalization of two new payment models, the January 2017 update of the ASC Payment System, an OIG report on vulnerabilities that remain under CMS' 2-Midnight Rule, and more!

December 20, 2016
Medicare Insider

This week’s note discusses the 21st Century Cures Act Section 603 amendments and the effect of the Act on hospital locations.

December 20, 2016
Medicare Insider

This week’s Medicare updates include Hospital Appeals Settlement Process FAQs, additional opportunities for clinicians under the Quality Payment Program, Conditions for Coverage for End-Stage Renal Disease Facilities interim final rule, and more!

December 13, 2016
Medicare Insider

This week’s note discusses the complex OPPS payment rules related to device offsets.

December 13, 2016
Medicare Insider

This week’s Medicare updates include the final Medicare Outpatient Observation Notice (MOON), a CY 2017 Update to the DMEPOS fee schedule, information on the CJR Model Skilled SNF 3-Day Rule Waiver, and more!

December 6, 2016
Medicare Insider

This week’s Medicare updates include the OIG’s Semiannual Report to Congress, an announcement that the Hospital Appeals Settlement Process is now open, a HCPCS Code Update for Preventive Services, and more!

December 6, 2016
Medicare Insider

This week’s note discusses the 2017 changes to chronic care management provided by rural health clinics.

November 30, 2016
Medicare Insider

This week’s note discusses updates to Medicare beneficiary cost sharing for 2017.

November 29, 2016
Medicare Insider

This week’s Medicare updates include a claims status category and claims status codes update, new waived tests, the reprocessing of some IPPS claims, and more!

November 22, 2016
Medicare Insider

This week’s note discusses the use of coding data in quality measures and patient safety initiatives.

November 22, 2016
Medicare Insider

This week’s Medicare updates include 2017 Annual Update to the Therapy Code List, a Proposed Decision Memo on Leadless Pacemakers, Provider Reimbursement Manual Hospital and Hospital Health Care Complex Cost Report Form CMS-2552-10 updates, and more!

November 16, 2016
Medicare Insider

This week’s note from the instructor discusses changes found in the 2017 OPPS Final Rule.

November 15, 2016
Medicare Insider

This week’s Medicare updates include the release of the OIG 2017 Work Plan, a CMS memorandum regarding noncompliance of transplant centers, an OIG report on unallowable claims for outpatient physical therapy services, and more!

November 9, 2016
Medicare Insider

This week’s note from the instructor discusses the 2017 OPPS final rule’s provisions for implementing Section 603 of the Bipartisan Budget Act of 2015, which requires an alternate payment system for certain off-campus provider-based services.

November 8, 2016
Medicare Insider

This week’s Medicare updates include the release of the End-Stage Renal Disease Prospective Payment System final rule, an announcement of the next round of Medicare Recovery Audit Contractors, the Hospital Outpatient Prospective Payment Changes for 2017 final rule, CY 2017 Home Health Prospective Payment System, a Hospital Appeals Settlement Update, and more!

November 1, 2016
Medicare Insider

This week’s Medicare updates include the release of FY 2017 Dialysis Facility Reports and End Stage Renal Disease Core Survey Materials; the Denial of Home Health Payments When Required Patient Assessment Is Not Received; a Quality Payment Program fact sheet, and more!

November 1, 2016
Medicare Insider

This week’s note from the instructor discusses PTAC, its mission, and submitting proposals.

October 25, 2016
Medicare Insider

This week’s Medicare updates include Fiscal Year 2017 Inpatient Prospective Payment System and Long Term Care Hospital PPS Changes; Revisions to State Operations Manual for Critical Access Hospitals (CAH) and Swing-Beds in CAHs; and more!

October 25, 2016
Medicare Insider

This week’s note from the instructor discusses corrections to the FY2017 IPPS final rule.

October 18, 2016
Medicare Insider

This week’s note from the instructor discusses CMS’ new Quality Payment Program.

October 18, 2016
Medicare Insider

This week’s Medicare updates include CMS’ Quality Payment Program; updates to the interest rate for Medicare overpayments and underpayments; a new initiative to increase clinician engagement; and more!

October 12, 2016
Medicare Insider

This week’s note from the instructor discusses commonly asked questions about patient status.

October 11, 2016
Medicare Insider

This week’s Medicare updates include the release of the October 2016 Medicare Quarterly Provider Compliance Newsletter; OIG reports on Medicare payments for clinical diagnostic laboratory tests; Reform of Requirements for Long-Term Care Facilities; and more!

October 5, 2016
Medicare Insider

This week’s Medicare updates include a transmittal recurring update notification describing changes to and billing instructions for various payment policies implemented in the October 2016 OPPS update; news about CMS once again allowing some providers to settle inpatient status claims in appeals; an OIG report regarding the improper payment of millions of dollars for unlawfully present beneficiaries; and more!

October 5, 2016
Medicare Insider

This week’s note from the instructor is about the use of modifier -CG on claims by rural health clinics.

September 28, 2016
Medicare Insider

This week’s Medicare updates include a story about the OIG levying its largest penalty under a corporate integrity agreement against nation's biggest provider of post-acute care; a fact sheet and press release about moving Medicare Advantage and Part D forward; and more!

September 28, 2016
Medicare Insider

This week’s note from the instructor is about changes resulting from the hospital readmission reduction program.

September 21, 2016
Medicare Insider

This week’s Medicare updates include a notice of interim final rule adjusting Civil Monetary Penalties; an article on the 2016-2017 influenza resources for healthcare professionals; and more!

September 21, 2016
Medicare Insider

This week’s note from the instructor is about ensuring orders for medical services are properly documented.

September 14, 2016
Medicare Insider

This week we have an excerpt from the Condition Codes 44 and W2 Training Handbook, by Kimberly Anderwood Hoy Baker, JD, CPC. For more information and to purchase, visit the HCPro Marketplace.

September 14, 2016
Medicare Insider

This week’s Medicare updates include 2017 Medicare EHR Incentive Program payment adjustment for hospitals; a fact sheet on Accountable Health Communities Model Track 1–Awareness; and more!

September 7, 2016
Medicare Insider

This week’s Medicare updates include the 2017annual Clotting Factor Furnishing Fee update; the 2017 HCPCS annual update reminder and more!

September 7, 2016
Medicare Insider

This week we have an excerpt from Observation Services Training Handbook, written by Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW. For more information and to purchase, visit the HCPro Marketplace.

August 30, 2016
Medicare Insider

This week’s note is about policies regarding coverage rules.

August 30, 2016
Medicare Insider

This week’s Medicare updates include coding revisions to NCDs; updated home health agency beneficiary notices; and more!

August 24, 2016
Medicare Insider

This week's note is about reporting and returning overpayments, as discussed in the Overpayments final rule.

August 24, 2016
Medicare Insider

This week’s Medicare updates include the October 2016 Integrated Outpatient Code Editor specifications version 17.3; the Medicare Fee for Service (FFS) Recovery Audit program third quarter summary newsletter; and more!

August 17, 2016
Medicare Insider

On July 7, CMS posted a fact sheet regarding a newly proposed Diabetes Prevention Program. This new benefit was proposed in the calendar year 2017 Medicare Physician Fee Schedule proposed rule.

August 17, 2016
Medicare Insider

This week’s Medicare updates include a Multiple Procedure Payment Reduction on the Professional Component of certain diagnostic imaging procedures; a new condition code to use when hospice recertification is untimely and corrections to hospice processing problems; and more!

August 10, 2016
Medicare Insider

This week’s Medicare updates include an update to inpatient psychiatric facilities PPS (IPF PPS) FY 2017; a Comprehensive Primary Care Plus (CPC+) region announcement; and more!

August 10, 2016
Medicare Insider

This week’s note is a continuation of last week’s note about potential changes to provider-based billing in the OPPS proposed rule.

August 3, 2016
Medicare Insider

This week’s updates include a notice of proposed rulemaking for bundled payment models for high-quality, coordinated cardiac and hip fracture care; FY 2017 rate update for inpatient psychiatric facilities PPS; and more!

August 3, 2016
Medicare Insider

This week’s note is about potential changes to provider-based billing in the OPPS proposed rule.

July 27, 2016
Medicare Insider

This week's note is about CMS' 2017 OPPS proposals for device packaging.

July 26, 2016
Medicare Insider

This week’s updates include the quarterly update to the CCI edits; denial codes for missing or insufficient documentation; and more!

July 20, 2016
Medicare Insider

This week’s note is about proposed changes to inpatient-only procedures in the OPPS proposed rule.

July 19, 2016
Medicare Insider

This week’s updates include a notice of proposed rulemaking for Organ Procurement Organizations and Transplant Centers; July 2016 Medicare Quarterly Provider Compliance Newsletter; and more!

July 13, 2016
Medicare Insider

This week’s updates include OPPS 2017 proposed rule; clarifications to stem cell transplantation for multiple myeloma, myelofibrosis, sickle cell disease, and myelodysplastic syndromes change request; and more!

July 13, 2016
Medicare Insider

This week’s note is about laws impacting Medicare fraud and overpayments.

July 6, 2016
Medicare Insider

This week’s updates include new waived tests; appeals of claims decisions, revisions to timeliness requirements for forwarding misfiled appeal requests, reconsideration request form, and guidelines for writing appeals correspondence; and more! 

July 6, 2016
Medicare Insider

The following is an excerpt from Inpatient-Only Procedures Training Handbook, written by Debbie Mackaman, RHIA, CPCO, CCDS. For more information and to purchase, visit the HCPro Marketplace.

June 28, 2016
Medicare Insider

This week’s note is about the OIG’s Mid-year Work Plan.