April 2, 2020
Medicare Insider

This week's note from the instructor discusses the provisions of the CARES Act that are most pertinent to Medicare benefits, providers, and suppliers. 

April 1, 2020
Medicare Insider

This week’s Medicare updates include a new process for survey activities during the current public health emergency, the passage of the CARES Act, an FAQ on the OIG’s new telehealth policies, and more!

March 26, 2020
Medicare Insider

This week's note from the instructor explains the expansion of telehealth and the accompanying billing guidance during the COVID-19 public health emergency.

March 25, 2020
Medicare Insider

This week’s Medicare updates include information on expanded telehealth benefits, a chart on contractor pricing for COVID-19 testing, recommendations on elective surgeries during the public health emergency, and more!

March 19, 2020
Medicare Insider

This week's note from the instructor examines the key proposals from the Comprehensive Care for Joint Replacement Model proposed rule. 

March 18, 2020
Medicare Insider

This week's Medicare updates include a plethora of information on COVID-19 coverage, payment, and infection control guidance; a new Part D savings model focused on lowering insulin costs; a final rule on interoperability and patient access; and more!

March 12, 2020
Medicare Insider

This week's note from the instructor looks at some of the most signifcant changes included in the April 2020 Outpatient Prospective Payment System (OPPS) update. 

March 11, 2020
Medicare Insider

This week’s Medicare updates include a variety of new information on coronavirus coding and billing, the quarterly update to the OPPS, and the quarterly update to the clinical laboratory fee schedule.

March 5, 2020
Medicare Insider

This week's note from the instructor walks through guidance on coding and reporting strategies for coronavirus and provides links to numerous resources for healthcare providers and facilities on managing the coronavirus response. 

March 4, 2020
Medicare Insider

This week’s Medicare updates include an article on elements necessary to include on orders or prescriptions for certain DMEPOS items, an NCA on colorectal cancer blood-based biomarker tests, a change to the Medicare Physician Fee Schedule database update file, and more!

February 27, 2020
Medicare Insider

This week's note from the instructor walks through the nuances of decoding transmittals by using a recent transmittal on national coverage determination changes as a case study. 

February 26, 2020
Medicare Insider

This week’s Medicare updates include four new items added to the OIG work plan, a new version of the integrated denial notice form, a transmittal implementing numerous regulatory revisions to the State Operations Manual, and more!

February 20, 2020
Medicare Insider

This week's note from the instructor discusses the new billing and coverage requirements for opioid treatment programs that went into effect January 1. 

February 19, 2020
Medicare Insider

This week’s Medicare updates include an article on billing and payment provisions for therapy services under PDGM, an update to the list of DMEPOS items that require prior authorization, a new code to use for coronavirus lab tests, and more! 

February 13, 2020
Medicare Insider

This week's note from the instructor reviews changes to Stark Law advisory opinions for 2020. 

February 6, 2020
Medicare Insider

This week's note from the instructor reviews the new OPPS pass-through devices for 2020 and the associated coding and billing requirements. 

February 5, 2020
Medicare Insider

This week’s Medicare updates include a final decision memo on an NCD for next generation sequencing tests, an update to manual guidance on prior authorization, a guide to billing and coding for mental health services, and more! 

January 30, 2020
Medicare Insider

This week's note from the instructor discusses two requirements for laboratories and the delays and updates pertaining to them.

January 29, 2020
Medicare Insider

This week’s Medicare updates include a Q&A on changes to new technology add-on payments pertaining to antibiotics, a decision memo on coverage for acupuncture as a treatment for chronic low back pain, implementation details for a new ICD-10-CM code for vaping-related disorder, and more! 

January 23, 2020
Medicare Insider

This week's note from the instructor discusses the new appropriate use criteria reporting requirements for providers ordering advanced diagnostic imaging services in 2020. 

January 22, 2020
Medicare Insider

This week’s Medicare updates include a new addition to the OIG work plan, the January edition of the Medicare Quarterly Compliance Newsletter, the January 2020 update to the Outpatient Prospective Payment System, and more!

January 16, 2020
Medicare Insider

This week's note from the instructor discusses the bundling rules and exceptions for billing outpatient services during the three-day payment window.  

January 15, 2020
Medicare Insider

This week’s Medicare updates include a Special Edition MLN Matters article on appropriate use criteria changes, updates to beneficiary notice forms, a beta version of an ICD-10-CM browsing tool, and more!

January 9, 2020
Medicare Insider

This week's note from the instructor reviews the prior authorization process that will be implemented for five categories of services in 2020. 

January 8, 2020
Medicare Insider

This week’s Medicare updates include transmittals on new provider specialty codes for opioid treatment programs, the implementation transmittal for the Ambulatory Surgical Center Payment System, correction notices for the 2020 Medicare Physician Fee Schedule final rule and Outpatient Prospective Payment System final rule, and more! 

January 2, 2020
Medicare Insider

This week's note from the instructor walks through the background of and processes involved in creating a Medicare Coverage Analysis document prior to billing for a clinical trial. 

December 19, 2019
Medicare Insider

This week's note from the instructor walks through the recent twists and turns of the legal fight against CMS' site-neutral payment reductions. 

December 18, 2019
Medicare Insider

This week’s Medicare updates include details on repayments to outpatient clinic visits at excepted off-campus provider-based departments, a new ICD-10-CM code for vaping-related disorder, an article on home infusion therapy billing, and more! 

December 12, 2019
Medicare Insider

This week's note from the instructor analyzes the impact of the 2020 updates to Medicare premiums, deductibles, coinsurance, and cost sharing amounts.

December 11, 2019
Medicare Insider

This week’s Medicare updates include a fact sheet on opioid treatment programs, revisions to skilled nursing facility cost reports, the CY 2020 update to the DMEPOS fee schedule, and more!

December 5, 2019
Medicare Insider

This week's note from the instructor examines the impact of the Outpatient Prospective Payment System and Medicare Physician Fee Schedule final rules on critical access hospitals (CAH) and rural health clincis (RHC). 

December 4, 2019
Medicare Insider

This week’s Medicare updates include the implementation transmittal for the 2020 Medicare Physician Fee Schedule, two Special Edition MLN Matters articles on the implementation of the Patient-Driven Groupings Model, home health billing compliance information, and more!

November 27, 2019
Medicare Insider

This week’s Medicare updates include a variety of new initiatives aimed toward improved safety and quality at nursing homes, updated fact sheets on opt-in and voluntary reporting procedures for MIPS, a comment request on an information collection regarding the MOON, and more!

November 27, 2019
Medicare Insider

This week's note from the instructor looks at the impact recent changes to beneficiary notices will have on providers. 

November 21, 2019
Medicare Insider

This week's note from the instructor discusses the elimination of the direct supervision requirement for all hospital outpatient therapeutic services effective January 1, 2020. 

November 20, 2019
Medicare Insider

This week’s Medicare updates include two rules on price transparency, updates to medical review requirements for SNFs, annual updates to the therapy code list, and more!

November 14, 2019
Medicare Insider

This week's note from the instructor explores considerations chargemaster coordinators should make regarding routine services in general medical/surgical units, specialty/intensive care units, and incidental nursing or bedside procedure charges. 

November 13, 2019
Medicare Insider

This week’s Medicare updates include a fact sheet on HIPAA privacy requirements, enrollment information for opioid treatment programs, implementation of end-stage renal disease payment rate updates, and more! 

November 7, 2019
Medicare Insider

This week's note from the instructor explores coding and billing for the new care management services established by the Medicare Physician Fee Schedule final rule. 

November 5, 2019
Medicare Insider

This week’s Medicare updates include the Outpatient Prospective Payment System final rule, the Medicare Physician Fee Schedule final rule, a proposed decision memo on genetic testing for cancer, and more!   

October 31, 2019
Medicare Insider

This week's note from the instructor discusses operational considerations to make while implementing new billing processes for therapy assistant modifiers. 

October 30, 2019
Medicare Insider

This week’s Medicare updates include the October edition of the Medicare Quarterly Compliance Newsletter, a pair of requests for information on potential usage of artificial intelligence to prevent fraud, Medicare Advantage billing instructions for CAR-T therapy, and more!

October 24, 2019
Medicare Insider

This week's note from the instructor reviews the updated Inpatient Prospective Payment System (IPPS) rates published in the correction notice for the final rule. 

October 23, 2019
Medicare Insider

This week’s Medicare updates includes 2020 payment rates for the Medicare Diabetes Prevention Program, updates to the OIG work plan, guidance on coding for encounters related to vaping illnesses, and more! 

October 17, 2019
Medicare Insider

This week's note from the instructor looks at Medicare regulations and requirements regarding hospital pricing of services.

October 16, 2019
Medicare Insider

This week’s Medicare updates include a pair of proposed rules on revisions to Stark Law, a correction notice for the IPPS final rule, updates to the amount in controversy thresholds for CY 2020, and more!

October 10, 2019
Medicare Insider

This week's note from the instructor addresses the broad range of directives included in a recent Executive Order aimed at improving Medicare Advantage and reducing burden on providers. 

October 9, 2019
Medicare Insider

This week’s Medicare updates include a Special Edition MLN Matters article on diabetes screening tests, revisions to the ambulatory surgical center October payment system update, manual changes related to implementation of the SNF Patient Driven Payment Model, and more!

October 3, 2019
Medicare Insider

This week's note from the instructor focuses on updates to the inpatient quality programs and examines their impact on MS-DRG payment calculations. 

October 2, 2019
Medicare Insider

This week’s Medicare updates include a final rule on revisions to discharge planning requirements, a handful of resources regarding a fraudulent genetic testing scheme, revisions to quality policies and procedures for laboratories, and more! 

September 26, 2019
Medicare Insider

This week's note from the instructor discusses a change that will be implemented in October to address issues related to device-dependent procedure edits. 

September 25, 2019
Medicare Insider

This week’s Medicare updates include an OIG review of emergency ambulance transports from hospitals to skilled nursing facilities, revisions to the State Operations Manual regarding critical access hospitals adding provider-based locations, coding revisions for national coverage determinations, and more!

September 19, 2019
Medicare Insider

This week's note from the instructor reviews recent clarifications for the use of revenue coes 0942 and 0240 when billing for hospital inpatient Part B services. 

September 18, 2019
Medicare Insider

This week’s Medicare updates include an article for health care professionals to use as a resource throughout the 2019-20 flu season, an OIG data brief on using CERT data to identify high-risk home health agencies, revisions to the Claims Processing Manual regarding billing for Part B inpatient services, and more! 

September 12, 2019
Medicare Insider

This week's note from the instructor looks at the ongoing judicial actions pertaining to discharge appeal rights for Medicare beneficiaries assigned to outpatient status or who have received observation services.

September 11, 2019
Medicare Insider

This week’s Medicare updates include information on Hurricane Dorian waivers for Florida, the Carolinas, and Georgia; a final rule on provider enrollment changes aimed at minimizing the risk of fraudulent practices; the October update of the ambulatory surgical center payment system, and more!  

September 5, 2019
Medicare Insider

This week's note from the instructor offers tips and tricks to simplify the process of distinguishing routine and research costs when billing for clinical trials. 

September 4, 2019
Medicare Insider

This week’s Medicare updates include information on waivers and extensions for places affected by Hurricane Dorian, the October updates for the OPPS and DMEPOS fee schedule, the implementation on a policy revising requirements for appeals signatures, and more!  

August 29, 2019
Medicare Insider

This week's note from the instructor examines the impact of CMS' 2020 payment rules on rural health clinics and critical access hospitals. 

August 28, 2019
Medicare Insider

This week’s Medicare updates include a Special Edition MLN Matters article on the new documentation requirements for cost reports, revised manual instructions related to the implementation of the Patient-Driven Groupings Model, an OIG review of the impact of price substitutions based on average sales price data, and more!

August 22, 2019
Medicare Insider

This week's note from the instructor explores proposals from the 2020 Medicare Physician Fee Schedule proposed rule and items for revenue cycle staff to consider commenting on before the comment period closes September 27. 

August 21, 2019
Medicare Insider

This week’s Medicare updates include a new tracking sheet for a national coverage analysis of transcatheter mitral valve repair procedures, the October 2019 update to drug and biologicals HCPCS codes, the October 2019 update to the Medicare Physician Fee Schedule database, and more!  

August 15, 2019
Medicare Insider

This week's note from the instructor delves into the key policies from the 2020 Inpatient Prospective Payment System (IPPS) final rule which revenue cycle staff need to familiarize themselves with prior to implementation on October 1, 2019. 

August 14, 2019
Medicare Insider

This week’s Medicare updates include the release of the 2020 ICD-10-CM coding guidelines, a decision memo on chimeric antigen receptor T-cell therapy, a booklet on critical access hospital requirements, and more!  

August 8, 2019
Medicare Insider

This week's note from the instructor examines some of the key proposed policies from the Outpatient Prospective Payment System proposed rule, including policies on general supervision, site neutrality, 340B payments, and price transparency. 

August 1, 2019
Medicare Insider

This week's note from the instructor checks in on the current status of the 340B court case in light of CMS' request for comments in the 2020 OPPS proposed rule on ways to remedy the 340B reimbursement adjustments. 

July 31, 2019
Medicare Insider

This week’s Medicare updates include the July edition of the Quarterly Compliance Newsletter, a guide on how to use diagnosis codes to help identify unreported abuse or neglect, provider compliance tips regarding documentation for diabetic supplies, and more!

July 25, 2019
Medicare Insider

This week's note from the instructor discusses ways clinical trial billing rules apply to more than just research and how they affect billing for free drugs or devices. 

July 24, 2019
Medicare Insider

This week’s Medicare updates include an article on waivers available in Louisiana to assist in the recovery efforts from Tropical Storm Barry, a proposed rule on increased flexibilities for long-term care facilities, a proposed decision memo on coverage of acupuncture for low back pain, and more!

July 18, 2019
Medicare Insider

This week's note from the instructor looks at a few issues pertaining to rural health clinics that remain unsolved either due to conflicting or lacking guidance from CMS. 

July 17, 2019
Medicare Insider

This week’s Medicare updates include the CY 2020 Home Health Prospective Payment System proposed rule, a series of OIG reports on hospice deficiencies, the new interest rate for Medicare overpayments and underpayments, and more!

July 11, 2019
Medicare Insider

This week's note from the instructor addresses some of the issues arising from the start of a new Quality Improvement Organization (QIO) contracting cycle. 

July 10, 2019
Medicare Insider

This week’s Medicare updates include a decision memo for an ambulatory blood pressure monitoring NCD, another extension of enforcement discretion for the laboratory date of service exception policy, a fact sheet on proper billing processes for DMEPOS items delivered to inpatients, and more!

July 3, 2019
Medicare Insider

This week’s Medicare updates include a policy clarification regarding negative wound therapy, an executive order on price transparency, and more! 

June 27, 2019
Medicare Insider

This week's note from the instructor discusses the circumstances surrounding a bill introduced in Congress in March that would include observation care in the three-day stay requirement for skilled nursing facility (SNF) coverage. 

June 26, 2019
Medicare Insider

This week’s Medicare updates include the release of the 2020 ICD-10-CM codes, new voluntary appeals settlement options for inpatient rehabilitation facilities, updated instructions for organ transplant programs, and more! 

June 20, 2019
Medicare Insider

This week's note from the instructor reviews a recent CMS report on the Innovation Center's progress in testing new payment and service delivery models. 

June 19, 2019
Medicare Insider

This week’s Medicare updates include the extension of a final rule on improvements for acute care and critical access hospitals, an OIG report on potential abuse and neglect at skilled nursing facilities, a revision to the July update of HCPCS codes, and more!  

June 13, 2019
Medicare Insider

This week's note from the instructor looks at the progress CMS has made in reducing burden through the Patients over Paperwork initiative and explores potential topics for providers to comment on to drive additional improvement. 

June 12, 2019
Medicare Insider

This week’s Medicare updates include an OIG review of a hospital’s skewed wage data, a court-ordered explanation on methodology for certain IPPS calculations, a memo on changes to timelines on investigations for deaths associated with restraint or seclusion, and more!

June 6, 2019
Medicare Insider

This week's note from the instructor examines the changes included in the July update of the Outpatient Prospective Payment System (OPPS). 

June 5, 2019
Medicare Insider

This week’s Medicare updates include an in-depth article on CAR T-Cell billing, a transmittal on changes to postpayment additional documentation request sample letters, a correction to the Inpatient Rehabilitation Facility Prospective Payment System proposed rule, and more!

May 30, 2019
Medicare Insider

This week's note from the instructor discusses NCCI edit changes and ways to resolve edit issues before they become an issue at late stages of the billing process. 

May 29, 2019
Medicare Insider

This week’s Medicare updates include a series of OIG reviews of home health billing, the July 2019 update of the OPPS and I/OCE, a report on how health IT influences care coordination in accountable care organizations, and more!

May 23, 2019
Medicare Insider

This week's note from the instructor provides an overview of the Medicare Physician Fee Schedule Database and how to track any changes or updates to it. 

May 22, 2019
Medicare Insider

This week’s Medicare updates include a final rule on Medicare Advantage drug pricing, the quarterly update for HCPCS drug/biological codes, an update to claim status and claim status category codes, and more!  

May 16, 2019
Medicare Insider

This week's note from the instructor delves into an issue with inpatient-only procedures that may result from wording in the 2019 Inpatient Prospective Payment System (IPPS) final rule.  

May 15, 2019
Medicare Insider

This week’s Medicare updates include a new Home Health Change of Care Notice, a final rule regarding drug pricing transparency, new information on patient relationship categories and codes, and more!

May 9, 2019
Medicare Insider

This week's note from the instructor examines recently released guidance from CMS on the modernization of the local coverage determination process. 

May 8, 2019
Medicare Insider

This week’s Medicare updates include a draft of guidance for hospital co-location, additional instructions for implementation of the Patient-Driven Groupings Model, a proposed rule on changes of ownership for accrediting organizations, and more!

May 2, 2019
Medicare Insider

This week's note from the instructor provides an overview of major proposals from the FY 2020 Inpatient Prospective Payment System proposed rule. 

May 1, 2019
Medicare Insider

This week’s Medicare updates include the Inpatient Prospective Payment System proposed rule, the announcement of a set of voluntary payment models focusing on primary care, the quarterly update for the End-Stage Renal Disease Prospective Payment System, and more! 

April 25, 2019
Medicare Insider

This week's note from the instructor discusses recent clarifications from CMS on swing-bed billing for critical access hospitals. 

April 24, 2019
Medicare Insider

This week’s Medicare updates include proposed rules for the inpatient rehabilitation facility, inpatient psychiatric facility, and skilled nursing facility payment systems; a proposed rule on the 2020 hospice payment rate update; a draft of new guidance on ligature risks; and more! 

April 17, 2019
Medicare Insider

This week’s Medicare updates include a final rule introducing new benefits for Medicare Advantage, details on a nationwide Medicare brace scam, a proposed decision memo for ambulatory blood pressure monitoring, and more!  

April 11, 2019
Medicare Insider

This week's note from the instructor discusses some of the ethical concerns case managers and potentially other types of healthcare professionals may face when utilizing technology such as social media, mobile devices, and electronic health portals. 

April 10, 2019
Medicare Insider

This week’s Medicare updates include the Medicare Advantage and Part D rate announcement and final call letter, a fact sheet on the Preclusion List, updates to provider self-disclosure settlements, and more! 

April 4, 2019
Medicare Insider

This week's note from the instructor examines current Medicare coverage and standards for telehealth services. 

April 3, 2019
Medicare Insider

This week’s Medicare updates include a proposed decision memo for transcatheter aortic valve replacements, clarification on a transmittal regarding evaluation and management coding, an article on edits for OPPS providers with multiple service locations, and more!

March 28, 2019
Medicare Insider

This week's note from the instructor is the second in a two-part series that discusses the intricacies of Medicare's inpatient hospital lifetime reserve days benefit and the challenges associated with it.