December 6, 2018
Medicare Insider

This week's note from the instructor provides guidance on what type of information should be provided to patients during the informed consent process of clinical trials. 

December 5, 2018
Medicare Insider

This week’s Medicare updates include a proposed rule regarding changes to the Medicare Advantage program regulations and Prescription Drug Benefit program, a review of hospital wage data to determine vulnerabilities in the hospital wage index system, the Fall 2018 semiannual report to Congress, and more!

November 29, 2018
Medicare Insider

This week's note from the instructor explores payment implications for a new virtual check-in service, which will be implemented effective January 1, 2019, as a provision of the 2019 Physician Fee Schedule final rule.

November 28, 2018
Medicare Insider

This week’s Medicare updates include a proposed decision memo on a national coverage determination (NCD) for vagus nerve stimulation for treatment resistant depression, a new initiative to promote patient safety and quality of care in nursing homes, the implementation of an NCD for implantable cardiac defibrillators, and more!

November 21, 2018
Medicare Insider

This week’s Medicare updates include new additions to the OIG Work Plan, transmittals on implementation of the End-Stage Renal Disease Prospective Payment System (PPS) and Home Health PPS, and a Special Edition MLN Matters article on waivers to assist with wildfire relief in California.  

November 15, 2018
Medicare Insider

This week's note from the instructor reviews and offers recommendations on the top three patient status issues causing the most confusion for providers. 

November 8, 2018
Medicare Insider

This week's note from the instructor demonstrates how CY 2019 updates will affect premiums, deductibles, and coinsurance amounts for Medicare beneficiaries.

November 7, 2018
Medicare Insider

This week’s Medicare updates include final rules for the Outpatient Prospective Payment System, Medicare Physician Fee Schedule. End-Stage Renal Disease Prospective Payment System, and more!

November 1, 2018
Medicare Insider

This week's note from the instructor takes a deep dive into the proposals included in a new advance notice of proposed rulemaking aimed at reducing prescription drug prices. 

October 31, 2018
Medicare Insider

This week’s Medicare updates include an advance notice of proposed rulemaking regarding changes to Part B drug pricing, an OIG review of billing for inpatient services, the release of skilled nursing facility quality reporting data, and more! 

October 25, 2018
Medicare Insider

This week's note from the instructor examines new guidance from CMS on the use of templates in medical review. 

October 24, 2018
Medicare Insider

This week’s Medicare updates include a proposed rule on drug pricing transparency, an article on systemic validation edits for OPPS providers with multiple service locations, an update to the OIG Work Plan, and more! 

October 18, 2018
Medicare Insider

This week's note explores the denials evaluation process and discusses items to consider when determining whether to appeal. 

October 17, 2018
Medicare Insider

This week’s Medicare updates include a new national coverage analysis for ambulatory blood pressure monitoring, an article on CMS actions in Hurricane Michael relief efforts, the release of the 2019 Star Ratings for Medicare Advantage and Part D prescription drug plans, and more!

October 11, 2018
Medicare Insider

This week's note from the instructor provides and overview of some of the key corrections to the 2019 Inpatient Prospective Payment System (IPPS) final rule. 

October 10, 2018
Medicare Insider

This week’s Medicare updates include the Medicare Quarterly Provider Compliance Newsletter, the launch of a new eMedicare initiative, correction notices for the Inpatient Prospective Payment System and Skilled Nursing Facility Payment System final rules, and more!

October 4, 2018
Medicare Insider

This week's note from the instructor takes a closer look at Medicare Advantage in light of several recent CMS and OIG releases regarding the program. 

October 3, 2018
Medicare Insider

This week’s Medicare updates include a new Medicare preventive services education tool, the September edition of the Patients over Paperwork newsletter, an OIG audit of Medicare Advantage’s appeal outcomes, and more! 

September 27, 2018
Medicare Insider

This week's note from the instructor discusses a new exception to the Medicare Secondary Payer Questionnaire process that could reduce the frequency of when these questions need to be asked and enhance patient satisfaction. 

September 26, 2018
Medicare Insider

This week’s Medicare updates include information on special waivers to assist Medicare providers, suppliers, and beneficiaries impacted by Hurricane Florence; a proposed rule on changes to various Medicare requirements, Conditions of Participation, and Conditions of Coverage; a review of Medicare payments for clinical laboratory tests; and more! 

September 20, 2018
Medicare Insider

This week's note from the instructor looks at guidance from CMS on IMRT billing following the release of an OIG audit report citing a 100% error rate in billing certain IMRT planning services.

September 19, 2018
Medicare Insider

This week’s Medicare updates include CMS’ support for Hurricane Florence preparation, ICD-10 and other coding revisions to national coverage determinations, quarterly HCPCS drug/biological code changes, and more!

September 13, 2018
Medicare Insider

This week’s note from the instructor explores ways to implement new processes to meet CMS’ public list of standard charges requirement beginning in 2019.

September 12, 2018
Medicare Insider

This week’s Medicare updates include an MLN Booklet on billing and payment policies for global surgery packages, a reminder on edit requirements for non-OPPS providers, new guidance on swing-bed requirements, and more! 

September 6, 2018
Medicare Insider

This week's note from the instructor is the second in a two-part series reviewing some of the major provisions in the 2019 Inpatient Prospective Payment System final rule. This week's note reviews changes to payment factors and meaningful measures. 

September 5, 2018
Medicare Insider

This week’s Medicare updates include the first annual report on the Next Generation Accountable Care Organization model, a Special Edition MLN Matters article on when to review opioid use with beneficiaries, the introduction of a new way for Part D plans to manage formulary designs and options, and more! 

August 30, 2018
Medicare Insider

This week's note from the instructor is the first in a two-part series reviewing some of the major provisions in the 2019 Inpatient Prospective Payment System final rule. 

August 29, 2018
Medicare Insider

This week’s Medicare updates include an application of a payment adjustment for IPPS low-volume hospitals, an OIG review which found 100% non-compliance with billing regulations for intensity-modulated radiation therapy planning services, a fact sheet on submitting data for MIPS through the claims data submission process, and more!  

August 23, 2018
Medicare Insider

This week's instructor note examines some of the hidden impacts of provisions from the Medicare Physician Fee Schedule proposed rule, including certain proposed changes that would affect hospitals as well as physician practices. 

August 22, 2018
Medicare Insider

This week’s Medicare updates include new additions to the OIG work plan, a Special Edition MLN Matters article on coverage of diabetes supplies, a pair of comment requests, and more!

August 16, 2018
Medicare Insider

This week's note from the instructor reviews some of the major proposals in the 2019 Outpatient Prospective Payment System (OPPS) proposed rule and examines the impact these proposals may have on health systems.

August 15, 2018
Medicare Insider

This week’s Medicare updates include the introduction of step therapy for Medicare Advantage plans, a correction to the Medicare Physician Fee Schedule proposed rule, a new 2019 benefit for the Next Generation ACO model, and more!

August 9, 2018
Medicare Insider

This week's note from the instructor examines the many ways CMS is attempting to reduce burden in a variety of areas within the Medicare program. 

August 8, 2018
Medicare Insider

This week’s Medicare updates include final rules for the Inpatient Prospective Payment System, Skilled Nursing Facility Prospective Payment System, Inpatient Rehabilitation Facility Prospective Payment System, and more!

August 2, 2018
Medicare Insider

This week's note discusses ways the HIM department and coding team can assist in edit and denials management to improve revenue cycle processes. 

August 1, 2018
Medicare Insider

This week’s Medicare updates include the Outpatient Prospective Payment System proposed rule, a video on the proposed changes to evaluation and management coding, the July edition of the Patients Over Paperwork newsletter, and more!

July 26, 2018
Medicare Insider

This week's note from the instructor reviews ways to stay compliant when billing for infusions and what role the revenue cycle leadership can play in overseeing the billing process for these services. 

July 25, 2018
Medicare Insider

This week’s Medicare updates include three new additions to the OIG work plan, a transmittal regarding new CLIA waived tests, an update to the Medicare Benefit Policy Manual related to acute kidney injury, and more!   

July 19, 2018
Medicare Insider

This week's instructor's note addresses the coding implications of the proposed changes to E/M coding from the Medicare Physician Fee Schedule proposed rule.

July 18, 2018
Medicare Insider

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! 

July 12, 2018
Medicare Insider

This week's note from the instructor examines the intricacies of the home infusion therapy (HIT) benefit and the 2019 Home Health Prospective Payment System proposed rule's implementation of temporary HIT payments. 

July 11, 2018
Medicare Insider

This week’s Medicare updates include the release of the 2019 Home Health Prospective Payment System proposed rule, two new MACRA resources, additional instructions related to the new Medicare cards, and more!  

July 5, 2018
Medicare Insider

This week’s note discusses the patient access department’s role in using system editing to ensure all required payer information is obtained and documented on claims. 

June 28, 2018
Medicare Insider

This week's note from the instructor is the second part in a series on the Medicare Diabetes Prevention Program (MDPP). This edition of the series reviews appropriate ways of reporting and receiving reimbursement for MDPP services. 

June 27, 2018
Medicare Insider

This week’s Medicare updates include several changes to the July 2018 update of the Outpatient Prospective Payment System, the introduction of a new Data Element Library to help support interoperability, a request for information regarding possible changes to Stark Law, and more!

June 21, 2018
Medicare Insider

This week's note from the instructor reviews the impact recent updates to the National Correct Coding Initative (NCCI) edits and Integrated Outpatient Code Editor (IOCE) will have on billing processes.

June 20, 2018
Medicare Insider

This week’s Medicare updates include the release of the 2019 ICD-10-CM code set, numerous updates to the OIG Work Plan, a fact sheet detailing how CMS determines qualifying APM status in the Quality Payment Program, and more! 

June 14, 2018
Medicare Insider

This week's note from the instructor outlines the possible payment pitfalls of a coding clarification CMS included in the July 2018 update to the Outpatient Prospective Payment System. 

June 13, 2018
Medicare Insider

This week’s Medicare updates include an OIG study on increases in reimbursement totals for brand-name drugs in Part D, a Special Edition MLN Matters article on hospice billing and claims processing, the July 2018 quarterly update to the Durable Medical Equipment fee schedule, and more!   

June 7, 2018
Medicare Insider

This week's note from the instructor addresses the possible confusion hospitals may face when billing for anesthesia services. 

June 6, 2018
Medicare Insider

This week’s Medicare updates include the July updates for the OPPS and ambulatory surgical center payment system, a new national coverage analysis for vagus nerve stimulation as a treatment for treatment-resistant depression, an advisory opinion related to telemedicine, and more!

May 31, 2018
Medicare Insider

This week's note from the instructor digs into the details of the expanded Medicare Diabetes Prevention Program. The article is the first in a multi-part series covering all aspects of the initiative.

May 30, 2018
Medicare Insider

This week’s Medicare updates include corrections to the 2018 Quality Payment Program final rule, two OIG reviews on issues related to Round 2 of the Competitive Bidding Program, the quarterly update to Part B drug pricing files, and more! 

May 24, 2018
Medicare Insider

This week's note focuses on new clarifying guidance from CMS regarding signature requirements for physician orders and medical documentation. 

May 23, 2018
Medicare Insider

This week’s Medicare updates include the introduction of new drug spending dashboards to improve transparency, new cost reporting forms for community mental health centers and rural health clinics, the quarterly update to the Medicare Physician Fee Schedule Database, and more!

May 17, 2018
Medicare Insider

This week's note from the instructor discusses ways to manage conflicting guidance from CMS regarding add-on code edits and avenues to explore when disputing these edits.

May 16, 2018
Medicare Insider

This week’s Medicare updates include an interim final rule on durable medical equipment fee schedule rates for rural and non-contiguous areas, an advisory opinion on a possible violation of the federal anti-kickback statute, a quarterly update for the clinical laboratory fee schedule, and more! 

May 10, 2018
Medicare Insider

This week's note from the instructor is the second article in a series reviewing the coverage, billing, and payment rules for swing bed services. This edition of the series focuses on professional services related to swing beds as well as applicable billing and payment rules for swing beds in critical access hospitals (CAH) and non-CAH small rural hospitals.

May 9, 2018
Medicare Insider

This week’s Medicare updates include proposed rules for the FY 2019 Skilled Nursing Facility Prospective Payment System (PPS), Inpatient Rehabilitation Facility PPS, Inpatient Psychiatric Facility PPS, and Hospice Wage Index and Payment Rate Update; the quarterly listing of Medicare program issuances; a guide on multi-payer model requests for advanced APM determinations; and more!   

May 3, 2018
Medicare Insider

This week's note from the instructor explores the major provisions of the FY 2019 Inpatient Prospective Payment System proposed rule. 

May 2, 2018
Medicare Insider

This week’s Medicare updates include the release of the 2019 Inpatient Prospective Payment System proposed rule, the publication of the feedback CMS received following a request for information on initiatives to improve the quality of healthcare while reducing cost, the announcement of the new Data-Driven Patient Care Strategy, and more!

April 25, 2018
Medicare Insider

This week's note from the instructor digs into the deeper details of recently reissued Medicare guidance on drug testing and specimen validity testing in light of a recent OIG report on improper payments related to drug testing. 

April 25, 2018
Medicare Insider

This week’s Medicare updates include the April edition of the Medicare Quarterly Provider Compliance Newsletter, a new OIG compliance website providing resources for the public to use to ensure compliance, an updated OIG work plan, and more!

April 19, 2018
Medicare Insider

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. 

April 18, 2018
Medicare Insider

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! 

April 12, 2018
Medicare Insider

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. 

April 11, 2018
Medicare Insider

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! 

April 5, 2018
Medicare Insider

This week's note from the instructor guides you through the recent overhaul of the IOCE and explores some of the most pertinent changes included in the April quarterly update.  

April 4, 2018
Medicare Insider

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! 

March 29, 2018
Medicare Insider

This week's note examines a new Special Edition MLN Matters article, SE18002, and its impact on billing processes for OPPS providers with multiple service locations.

March 28, 2018
Medicare Insider

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!

March 22, 2018
Medicare Insider

This week’s note discusses drug coverage available under Parts A, B, and C, and it looks at ways Medicare Part D closes some of the gaps in Medicare coverage for prescription drugs. 

March 21, 2018
Medicare Insider

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! 

March 15, 2018
Medicare Insider

This week's note digs into the details of how healthcare providers should manage the transition to the new Medicare cards, which is slated to begin in April 2018. 

March 14, 2018
Medicare Insider

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! 

March 8, 2018
Medicare Insider

This week's note focuses on the Patients Over Paperwork initiative and the changes it created in the process for issuing the skilled nursing facility Advance Beneficiary Notice of Non-Coverage form. 

March 7, 2018
Medicare Insider

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! 

March 1, 2018
Medicare Insider

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.  

February 28, 2018
Medicare Insider

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! 

February 22, 2018
Medicare Insider

This week's note from the instructor reviews the terms and policies currently in use for telehealth services that are covered by Medicare. 

February 21, 2018
Medicare Insider

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! 

February 15, 2018
Medicare Insider

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. 

February 14, 2018
Medicare Insider

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! 

February 8, 2018
Medicare Insider

This week's note reviews changes to the clinical lab date of service policy initiated by the 2018 Outpatient Prospective Payment System. 

February 7, 2018
Medicare Insider

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! 

February 1, 2018
Medicare Insider

This week's note clarifies the rules, regulations, and provider considerations to take into accounting following CMS' decision to remove total knee arthroplasty from the inpatient-only list. 

January 31, 2018
Medicare Insider

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!   

January 25, 2018
Medicare Insider

This week's note delves into how to document time on claims for care management services provided in a rural health clinic and compares the new types of care management services for 2018. 

January 24, 2018
Medicare Insider

This week’s Medicare updates include the January 2018 edition of the Medicare Quarterly Compliance Newsletter, an update to the OIG work plan, the 2018 Value Modifier results, and more! 

January 18, 2018
Medicare Insider

This week's note examines the intricacies of the BPCI Advanced payment model, a new voluntary bundled payment model set to go live in October. 

January 17, 2018
Medicare Insider

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! 

January 11, 2018
Medicare Insider

This week's note reviews policies and procedures related to the usage of Hospital Issued Notice of Noncoverage 11.

January 10, 2018
Medicare Insider

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!   

January 4, 2018
Medicare Insider

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. 

January 3, 2018
Medicare Insider

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! 

December 27, 2017
Medicare Insider

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! 

December 21, 2017
Medicare Insider

This week's note provides an overview of the eligibility, scope of coverage, effective dates, premiums, and cost-sharing amount policies under the four parts of Medicare. . 

December 20, 2017
Medicare Insider

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!  

December 14, 2017
Medicare Insider

This week’s note details the approach chargemaster coordinators should take when conducting annual in-depth reviews with revenue departments.

December 13, 2017
Medicare Insider

This week’s Medicare updates include a reminder on proper inpatient billing procedures and a notice about revisions to the State Operations Manual.