July 29, 2021
Medicare Insider

This week's note from the instructor weighs the implications of the proposed price transparency penalties from the CY 2022 Outpatient Prospective Payment System proposed rule. 

July 28, 2021
Medicare Insider

This week’s Medicare updates include the renewal of the COVID-19 public health emergency, the publication of the CY 2022 Outpatient Prospective Payment System Proposed Rule, an emergency use authorization for a new type of COVID-19 monoclonal antibody treatment, and more!

July 21, 2021
Medicare Insider

This week's note from the instructor reviews recent changes to the Comprehensive Care for Joint Replacement Model. 

July 14, 2021
Medicare Insider

This week’s Medicare updates include the 2022 ESRD PPS Proposed Rule, two OIG advisory opinions, a proposed decision memo for an NCD on home oxygen, and more!

July 1, 2021
Medicare Insider

This week's note from the instructor looks at a recent clarification published by CMS on reimbursement for certain provider-based rural health clinics.

July 1, 2021
Medicare Insider

This week's note from the instructor looks at a recent clarification published by CMS on reimbursement for certain provider-based rural health clinics.

June 30, 2021
Medicare Insider

This week’s Medicare updates include download files for the 2022 ICD-10-CM codes, the July 2021 update of the Ambulatory Surgical Center Payment System, revised guidance on emergency preparedness requirements, and more!

June 24, 2021
Medicare Insider

This week's note from the instructor discusses coding, documentation, and billing requirements for polysomnography services in light of multiple recent OIG reviews of the topic. 

June 23, 2021
Medicare Insider

This week’s Medicare updates include billing information for a new monoclonal antibody treatment for COVID-19, additional items on the OIG Work Plan, an MLN fact sheet on billing for cardiac device credits, and more!

June 17, 2021
Medicare Insider

This week's note from the instructor shines a spotlight on a recent OIG audit of modifier -25 and how to appropriately report it. 

June 16, 2021
Medicare Insider

This week’s Medicare updates include a download link for the FY 2022 ICD-10-PCS code files, a new edition of the Medicare Quarterly Compliance Newsletter, information on additional payment for the COVID-19 vaccine in the patient’s home, and more! 

June 9, 2021
Medicare Insider

This week’s Medicare updates include a notice about the resumption of post-payment medical reviews, an OIG review of polysomnography services, a correction notice for the CY 2022 Medicare Advantage Program Policy and Technical Changes final rule, and more!

June 9, 2021
Medicare Insider

This week's note from the instructor looks at best practices for compliance officers in creating a plan to safeguard quality of care. 

June 2, 2021
Medicare Insider

This week’s Medicare updates include a fact sheet on provider documentation to facilitate collaborative care, an OIG review of CMS payments for end-stage renal disease monthly capitation payments, a new OIG FAQ item on enforcement discretion during the COVID-19 PHE, and more!

May 27, 2021
Medicare Insider

This week's note from the instructor reviews the proposed updates to quality reporting programs that were introduced in the FY 2022 Inpatient Prospective Payment System (IPPS) Proposed Rule. 

May 26, 2021
Medicare Insider

This week’s Medicare updates include three advisory opinions, a series of NCD transmittals, multiple OIG reviews of hospice compliance, and more!

May 24, 2021
Medicare Insider

This week's note from the instructor examines the requirements and changes made for the second year of CMS' prior authorization program for certain hospital outpatient department services.

May 19, 2021
Medicare Insider

This week’s Medicare updates include changes to the list of codes requiring prior authorization, an advance copy of implementation information for the Interoperability and Patient Access Final Rule, a resolution to an edit regarding DRG weights, and more!

May 13, 2021
Medicare Insider

This week's note from the instructor reviews the long-term care hospital payment and policy updates introduced in the FY 2022 Inpatient Prospective Payment System (IPPS) Proposed Rule. 

May 12, 2021
Medicare Insider

This week’s Medicare updates include an extension to the Comprehensive Care for Joint Replacement model, updates to payments for ambulance services during the PHE, increased payments for monoclonal antibodies, and more!

May 7, 2021
Medicare Insider

This week's note from the instructor reviews the inpatient hospital payment and policy updates introduced in the FY 2022 Inpatient Prospective Payment System (IPPS) Proposed Rule. 

May 5, 2021
Medicare Insider

This week’s Medicare updates include the 2022 IPPS proposed rule, a handful of cost reporting form updates, an MLN Booklet on using the Medicare Physician Fee Schedule look-up tool, and more!

April 29, 2021
Medicare Insider

The widespread adoption of electronic medical records and software has made it easier for coders to ensure that all necessary query elements are present. Nonetheless, coders must understand what these elements are.

April 22, 2021
Medicare Insider

This week's note from the instructor looks at the implications of a recent OIG brief on how Medicare Advantage organizations could use national provider identifiers (NPI) to monitor for fraud, waste, and abuse. 

April 21, 2021
Medicare Insider

This week’s Medicare updates include new instructions for COVID-19 monoclonal antibody infusions, an updated list of telehealth services payable under the Physician Fee Schedule, six new items added to the OIG work plan, and more! 

April 15, 2021
Medicare Insider

This week's note from the instructor examines the effect of virtual communication on case managers during the COVID-19 public health emergency (PHE).

April 14, 2021
Medicare Insider

This week’s Medicare updates include proposed rules for the inpatient psychiatric facility prospective payment system, skilled nursing facility prospective payment system, and the hospice payment rate update.

April 8, 2021
Medicare Insider

This week's note from the instructor explores changes to rural health clinic (RHC) reimbursement as a result of provisions in the Consolidated Appropriations Act

April 7, 2021
Medicare Insider

This week’s Medicare updates include the April update to the ambulatory surgical center payment system, information on COVID-19 Advanced and Accelerated Payment recoupment, an update on an issue with therapy claims, and more! 

April 1, 2021
Medicare Insider

This week's note from the instructor explores ways the post-acute care transfer rule can lead either to overpayments or underpayments and discusses some actions hospitals can take to ensure accurate payment. 

March 31, 2021
Medicare Insider

This week’s Medicare updates include claims processing instructions for a revised NCD, an update to the manual pertaining to cardiac/pulmonary rehab, updated information on hospital surveys during the COVID-19 PHE, and more!

March 25, 2021
Medicare Insider

This week's note from the instructor reviews the latest guidance on how to bill and code for COVID-19 vaccines and monoclonal antibodies. 

March 24, 2021
Medicare Insider

This week’s Medicare updates include updated billing requirement information for home infusion therapy services, an implementation delay with additional comment period for the Medicare Coverage of Innovative Technology final rule, updates to rural health clinic payment limits, and more!

March 18, 2021
Medicare Insider

This week's note from the instructor reviews the Intravenous Immune Globulin (IVIG) demonstration, which has been extended for an additional three years. 

March 17, 2021
Medicare Insider

This week’s Medicare updates include the quarterly OPPS and I/OCE update transmittals, new guidance on visitation at nursing homes, revisions to a behavioral health integration services guide, and more!

March 11, 2021
Medicare Insider

This week's note from the instructor looks at the implications for hospitals stemming from a recent OIG data brief on high severity inpatient stays. 

March 10, 2021
Medicare Insider

This week’s Medicare updates include a revised section in the COVID-19 Medicare billing FAQs, a fact sheet on the IVIG demonstration, an updated COVID-19 fraud alert, and more!

March 4, 2021
Medicare Insider

This note from the instructor explores the intricacies of the acute and post-acute transfer policy in light of recent OIG audits on hospital compliance with these policies.

March 3, 2021
Medicare Insider

This week’s Medicare updates include coding and payment information for the Johnson & Johnson COVID-19 vaccine, an OIG report on trends toward more expensive inpatient hospital stays, an MLN article on billing for services when Medicare is a secondary payer, and more!

February 25, 2021
Medicare Insider

This week's note from the instructor looks as how to use E/M risk assessments as part of a strategy to measure the level of compliance with laws, regulations, and internal policies and procedures.

February 24, 2021
Medicare Insider

This week’s Medicare updates include new items added to the OIG work plan, a download link for HCPCS codes which are excepted from the lab date of service policy, a new program instruction sheet for monoclonal antibodies used to treat COVID-19, and more!

February 17, 2021
Medicare Insider

This week’s Medicare updates include new information on reporting requirements for the Medicare ground ambulance data collection system, an EUA for a new type of monoclonal antibody treatment for COVID-19, details regarding an ESRD claims processing issue, and more!

February 11, 2021
Medicare Insider

This week's note from the instructor is the second article in a two-part series focusing on billing processes for alternative ways of delivering basic hospital outpatient services during the COVID-19 PHE. 

February 10, 2021
Medicare Insider

This week’s Medicare updates include notices on the delay of two final rules, updated provider fact sheets on COVID-19 PHE waivers and flexibilities, a note about payment for HCPCS code G2211, and more!

February 4, 2021
Medicare Insider

This week's note from the instructor explores the impact of CMS phasing out the inpatient-only list as finalized in the 2021 Outpatient Prospective Payment System (OPPS) final rule.

February 3, 2021
Medicare Insider

This week’s Medicare updates include a notice about reprocessing certain drug claims that were rejected in error, the latest version of the Medicare beneficiary COVID-19 data snapshot, a table on MAC pricing for COVID-19 testing, and more!

January 27, 2021
Medicare Insider

This week’s Medicare updates include FAQs on market-based MS-DRG relative weights, Opioid Treatment Program provider enrollment updates, two new decision memos on NCDs, and more!

January 21, 2021
Medicare Insider

This week's note from the instructor focus on billing processes for alternative ways of delivering basic hospital outpatient services during the COVID-19 PHE. 

January 20, 2021
Medicare Insider

This week’s Medicare updates include the CMS pandemic plan, a final rule on Medicare coverage of innovative technology, a final rule on prior authorization process improvements, and more!

January 14, 2021
Medicare Insider

This week's note from the instructor explains how the Most Favored Nation model will affect billing and payment for Part B drugs.

January 13, 2021
Medicare Insider

This week’s Medicare updates include payment adjustment information from the Consolidated Appropriations Act, revisions to information in the COVID-19 billing FAQ document, a notice of funding opportunity for development of radiology quality measures, and more! 

January 7, 2021
Medicare Insider

This week's instructor note discusses E/M auditing and highlights some of the most high-risk areas to monitor. 

January 6, 2021
Medicare Insider

This week’s Medicare updates include three advisory opinions, billing information for Most Favored Nation model drugs, the January 2021 OPPS update, and more! 

December 23, 2020
Medicare Insider

This week’s Medicare updates include three new OIG work plan topics, updated payment and coding information for the Pfizer-BioNTech COVID-19 vaccine, the 2021 Clinical Laboratory Fee Schedule changes, and more!

December 17, 2020
Medicare Insider

This note from the instructor explores recent changes made to local coverage determination (LCD) processes and policies and the beneficial impact of these changes on providers and beneficiaries

December 16, 2020
Medicare Insider

This week’s Medicare updates include an infographic on monoclonal antibody coverage, a revision to a Special Edition MLN Matters article on COVID-19 PHE flexibilities for rural health clinics, updated FAQs on billing for services related to COVID-19, and more!

December 10, 2020
Medicare Insider

This week's note from the instructor looks at how the 2021 OPPS and Medicare Physician Fee Schedule final rules will impact providers next year--and beyond.

December 9, 2020
Medicare Insider

This week’s Medicare updates include the Medicare Physician Fee Schedule final rule, the Outpatient Prospective Payment System final rule, additional guidance on coding and billing for monoclonal antibody treatments for COVID-19, and more!

December 3, 2020
Medicare Insider

This week's note from the instructor analyzes the impact of the 2021 updates to Medicare premiums, deductibles, coinsurance, and cost sharing amounts.

December 2, 2020
Medicare Insider

This week’s Medicare updates include new guidance on hospital expansion opportunities during the COVID-19 pandemic, revised guidance for ambulatory surgical center staffing during the pandemic, an interim final rule on payment for Part B drugs, and more!

November 25, 2020
Medicare Insider

This week’s Medicare updates include three new additions to the OIG Work Plan, a new webpage on billing and coding for COVID-19 monoclonal antibody treatment, a transmittal on the implementation of two new NUBC condition codes, and more!

November 19, 2020
Medicare Insider

This week's note from the instructor addresses the billing, coding, and payment instructions Medicare recently released for potential COVID-19 vaccines and new antibody treatments. 

November 18, 2020
Medicare Insider

This week’s Medicare updates include the implementation of the ESRD Prospective Payment System changes for CY 2021, instructions on billing and coding for a new COVID-19 monoclonal antibody treatment, an update to edits for vaccine services, and more!

November 12, 2020
Medicare Insider

This week's note from the instructor discusses a new OIG review of CMS payments for device credits in light of an apparent conflict between regulatory text and manual guidance.

November 11, 2020
Medicare Insider

This week’s Medicare updates include the End Stage Renal Disease Prospective Payment System final rule, an update to home health provisions in the Benefit Policy Manual to implement elements of the CARES Act, an OIG report on device credits, and more!

November 5, 2020
Medicare Insider

This week's note from the instructor discusses the latest interim final rule with comment (IFC) and its provisions concern vaccines, payments for new COVID-19 treatments, and more. 

November 4, 2020
Medicare Insider

This week’s Medicare updates include a new interim final rule on COVID-19 vaccination and payment policies, Part II of the CY 2022 Medicare Advantage and Part D Advance Notice, a proposed rule on DMEPOS coverage policies and fee schedule methodologies, and more!

October 29, 2020
Medicare Insider

This week's note from the instructor reviews types of risk areas that should be continuously monitored by compliance officers, as they are frequent targets for OIG reviews.

October 28, 2020
Medicare Insider

This week’s Medicare updates include the latest edition of the Medicare Quarterly Provider Compliance Newsletter, two new proposed decision memos on coverage for blood-based biomarker tests and a molecular expression test, updated information in the COVID-19 billing FAQs, and more!

October 22, 2020
Medicare Insider

This week's note from the instructor focuses on new Medicare guidance on and updated payment policies for COVID-19 testing, vaccines, and telehealth services.

October 21, 2020
Medicare Insider

This week’s Medicare updates include new payment incentives for COVID-19 testing, the addition of 11 services to the telehealth list, updated data on the impact of COVID-19 on Medicare beneficiaries, and more!

October 15, 2020
Medicare Insider

This week's note from the instructor discusses a new edit in the October release of the IOCE which might unveil exclusion issues within certain software systems.

October 14, 2020
Medicare Insider

This week’s Medicare updates include the re-release of the October 2020 I/OCE quarterly data files, details on new COVID-19 reporting requirements for hospitals and critical access hospitals, and information on repayments for loans issued under the Accelerated and Advance Payment program at the beginning of the PHE.

October 8, 2020
Medicare Insider

This week's note from the instructor walks through eligibility, coding, billing, and payment information for the new Primary Care First payment model.

October 7, 2020
Medicare Insider

This week’s Medicare updates include a new website devoted to price transparency, clarifications on guidance related to emergency preparedness requirements, updated COVID-19 blanket waivers for teaching hospitals, and more!

October 1, 2020
Medicare Insider

This week's note from the instructor explores the intricacies of Medicare's new mandatory radiation oncology model.

September 30, 2020
Medicare Insider

This week’s Medicare updates include revisions to the OPPS quarterly update implementation transmittal, slides on Medicare payment for COVID-19 viral testing at skilled nursing facilities, 2021 benefit and cost-sharing information for Medicare Advantage and Part D plans, and more! 

September 24, 2020
Medicare Insider

This week's note from the instructor reviews the FY 2021 updates to interoperability and other inpatient quality programs from the Inpatient Prospective Payment System (IPPS) final rule. 

September 23, 2020
Medicare Insider

This week’s Medicare updates include the 2022 Medicare Advantage and Part D Advance Notice, the final report from the Coronavirus Commission on safety and quality in nursing homes, a final rule on new specialty care payment models, and more! 

September 17, 2020
Medicare Insider

This week's note from the instructor discusses FY 2021 IPPS payment factors that currently determine Medicare reimbursement for acute hospital inpatient services.

September 16, 2020
Medicare Insider

This week’s Medicare updates include information on the reorganization of the Medicare Program Integrity Manual, updates to three provider-specific fact sheets on COVID waivers, the October 2020 update for the Ambulatory Surgical Center PPS, and more!

September 10, 2020
Medicare Insider

This week's note from the instructor addresses policies in the IPPS final rule which take steps toward a more market-based reimbursement methodology.

September 9, 2020
Medicare Insider

This week’s Medicare updates include the FY 2021 IPPS final rule, two new FAQs regarding OIG administrative enforcement during the COVID-19 pandemic, an update to model admission questions for Medicare as a secondary payer, and more!

September 3, 2020
Medicare Insider

This week's note from the instructor focuses on the implications of a proposed rule which would redefine the "reasonable and necessary" Medicare coverage standard and would create a new coverage pathway for devices.

September 2, 2020
Medicare Insider

This week’s Medicare updates include a new interim final rule with comment regarding COVID-19 data reporting and testing, the October update to the OPPS, a proposed rule on coverage for innovative devices, and more!

August 27, 2020
Medicare Insider

This week's instructor note dives into the recent instruction from CMS on requirements for reporting a COVID-19 diagnosis on a claim in order for the claim to be eligible for a payment increase. 

August 26, 2020
Medicare Insider

This week’s Medicare updates include new guidance on elective procedures for end-stage renal disease patients during the public health emergency, new additions to the OIG work plan, updated data on opioid use in Medicare Part D, and more!

August 20, 2020
Medicare Insider

This week's note from the instructor discusses the devastating impact of COVID-19 on skilled nursing and long-term care faciltiies, and it examines ways the federal government is assisting these facilties via regulatory and financial support. 

August 19, 2020
Medicare Insider

This week’s Medicare updates include a new payment model from the Innovation Center, a proposed decision memo regarding changes to two NCDs, information on the Advisory Panel on Hospital Outpatient Payment meeting, and more!

August 13, 2020
Medicare Insider

This week's note from the instructor discusses the impact of the proposed relative value unit (RVU) changes in the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule.

August 12, 2020
Medicare Insider

This week’s Medicare updates include the 2021 Quality Payment Program proposed rule, new FAQs regarding COVID-19 topics, the October update to the clinical laboratory fee schedule, and more!

August 6, 2020
Medicare Insider

This week's note from the instructor takes a first look at the 2021 Outpatient Prospective Payment System (OPPS) proposed rule and the possibility of sunsetting the inpatient-only list. 

August 5, 2020
Medicare Insider

This week’s Medicare updates include the release of the Skilled Nursing Facility Prospective Payment System final rule, new ICD-10-PCS codes for therapeutic COVID-19 treatments, the Inpatient Psychiatric Facility Prospective Payment System final rule, and more!

July 30, 2020
Medicare Insider

This week's note from the instructor discusses the new home infusion therapy (HIT) benefit and how it could help in the continuum of care during the COVID-19 pandemic.

July 29, 2020
Medicare Insider

This week’s Medicare updates include the renewal of the public health emergency for another 90 days, an advisory opinion on charitable organizations resolving medical debt, additional updates to COVID-19 billing FAQs, and more!

July 23, 2020
Medicare Insider

This week's note from the instructor reviews coding and documentation requirements for severe malnutrition in light of another OIG review of these types of claims. 

July 22, 2020
Medicare Insider

This week’s Medicare updates include new FAQ items for COVID-19 billing, updates to the OIG work plan, and another revision to the July 2020 OPPS update.

July 16, 2020
Medicare Insider

This week's note from the instructor discusses how to apply the blood deductible under Parts A and B, and it looks at the coverage, billing, and payment rules unique to blood products and related services. 

July 15, 2020
Medicare Insider

This week’s Medicare updates include the 2021 End Stage Renal Disease Prospective Payment System proposed rule, updates on assorted demonstration models that were paused during the COVID-19 public health emergency, reprocessing instructions for certain IPPS claims, and more! 

July 9, 2020
Medicare Insider

This week's note from the instructor discusses common questions related to patient status billing issues.