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.

December 7, 2017
Medicare Insider

This week's note from the instructor examines the process of deciding when to appeal a denial. 

December 6, 2017
Medicare Insider

This week’s Medicare updates include an extension for S-10 worksheet submission, implementation plans for computed radiography payment reductions, a new national coverage article for a genetic sequencing diagnostic test for cancer patients, and more!

November 30, 2017
Medicare Insider

This week's note from the instructor discusses ways to resolve Medicare billing edits. 

November 29, 2017
Medicare Insider

This week’s Medicare updates include the announcement of the Part A and Part B premiums and deductibles for 2018, clarification on new Conditions of Participation regarding home health agency subunits, a proposed decision memo on conditions of coverage for implantable cardioverter defibrillators, and more! 

November 22, 2017
Medicare Insider

This week’s Medicare updates include an advisory opinion on using network hospitals for inpatient stays; annual updates to HCPCS codes used for home health consolidated billing and the therapy code list; the removal of hyperbaric oxygen therapy (topical application of oxygen) from an NCD; and more! 

November 16, 2017
Medicare Insider

This week’s note is the third in a series of articles examining coding, billing, and payment rules for rural health clinics.

November 15, 2017
Medicare Insider

This week’s Medicare updates include new hospital appeals settlement options, revisions involving the addition and deletion of ICD-10-CM codes from certain NCDs, details on the partial settlement of a 2-Midnight policy court case, and more! 

November 9, 2017
Medicare Insider

This week's note reviews two major policy changes from the OPPS and MPFS final rules: the reduction in reimbursement for 340B drugs and the reduction in the payment adjustment for non-excepted off-campus provider-based departments. 

November 8, 2017
Medicare Insider

This week’s Medicare updates include the OPPS, Quality Payment Program, End-Stage Renal Disease, and Medicare Physician Fee Schedule final rules; an announcement of the new Meaningful Measures initiative; a list of new Clinical Laboratory Improvement Amendments waived tests; and more! 

November 2, 2017
Medicare Insider

This week's note reviews pre-service coverage analysis processes in light of the recent CMS decision to delegate the target, probe, and educate medical review strategy to the Medicare Administrative Contractors. 

November 1, 2017
Medicare Insider

This week’s Medicare updates include the quarterly listing of program issuances, a fact sheet on the federal health exchange’s 2018 open enrollment period, revised instructions for certificate of medical necessity and durable medical equipment information forms, and more! 

October 26, 2017
Medicare Insider

This week’s note is the second in a series of articles examining coding, billing, and payment rules for rural health clinics.

October 25, 2017
Medicare Insider

This week’s Medicare updates include additional government guidance on wildfires and hurricanes, modifications to proof of delivery requirements, clarification on billing of immunosuppressive drugs, and more! 

October 19, 2017
Medicare Insider

This week’s note reviews standards and methods for tracking functionality of implantable medical devices.

October 18, 2017
Medicare Insider

This week’s Medicare updates include notification of a new interest rate for Medicare Overpayments and Underpayments, revisions to the Medicare Claims Processing Manual regarding payment of services furnished by qualified nonphysician anesthetists, a fact sheet for hospitals on the 2018 Medicare EHR Incentive Program payment adjustment, and more!  

October 12, 2017
Medicare Insider

This week's note reviews changes to the Medicare Clinical Laboratory Fee Schedule effective January 1, 2018. 

October 11, 2017
Medicare Insider

This week’s Medicare updates include corrections to the IPPS final rule; corrections to the Skilled Nursing Facilities Prospective Payment System final rule; year 3 baseline data on Medicare payments for clinical diagnostic laboratory tests; and more!

October 5, 2017
Medicare Insider

This week's note reviews ways to satisfy the three-day hospitalization requirement for placing a patient in a skilled nursing facility. 

October 4, 2017
Medicare Insider

This week’s Medicare updates include clarification on portable x-ray necessity, recommendations from the hospital outpatient payment advisory panel, an adjustment to the amount in controversy threshold amounts for 2018, and more!

September 28, 2017
Medicare Insider

This week's note reviews a recent Office of Inspector General report that found a 100% failure rate among reviewed claims. 

September 26, 2017
Medicare Insider

This week’s Medicare updates include an OPPS update; guidance on coding and billing date of service on professional claims; CMS’ efforts to support Puerto Rico and the U.S. Virgin Islands in the wake of Hurricane Maria; and more!

September 21, 2017
Medicare Insider

This week's note looks at coding, billing, and payment rules for rural health clinics.

September 20, 2017
Medicare Insider

This week’s Medicare updates include information on submitting claims to Medicare for beneficiaries in Florida affected by Hurricane Irma; annual HCPCS updates for SNFs; FY 2018 IPPS and LTCH PPS updates; and more!

September 14, 2017
Medicare Insider

This week's note looks at how to accurately calculate new technology add-on payment charges and ensure your facility is appropriately reimbursed for them.

September 13, 2017
Medicare Insider

This week’s Medicare updates include an update to the Ambulatory Surgical Center Payment System; revisions to the State Operations Manual; information on CMS approval of CHIP provisions to assist with Hurricane Harvey disaster relief; and more!

September 7, 2017
Medicare Insider

This week's note from the instructor discusses the four main types of provider-based departments.

September 6, 2017
Medicare Insider

This week’s Medicare updates include CMS' response to Hurricane Harvey; the retirement of tobacco cessation counseling coverage; a new OIG Advisory Opinion; and more!

August 31, 2017
Medicare Insider

This week's note from the instructor explores the recent October Quarterly Updates for hospitals. 

August 30, 2017
Medicare Insider

This week's Medicare updates include a new OIG advisory opinion; the October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS); the Inpatient Rehabilitation Facility (IRF) Annual Update; and more!

August 24, 2017
Medicare Insider

On August 14, CMS published the FY2018 Inpatient Prospective Payment System Final Rule; with it came discussion and a notice in regards to the 96-hour certification requirement for critical access hospitals (CAH).

August 17, 2017
Medicare Insider

This week's note from the instructor examines proposed changes to the clinical lab Date of Service (DOS).

August 15, 2017
Medicare Insider

This week's Medicare updates include the 2018 Inpatient Psychiatric Facilities Prospective Payment System Update; Revisions to the Home Health Pricer to Support Value-Based Purchasing and Payment Standardization; Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS); and more!

August 9, 2017
Medicare Insider

This week's Medicare updates include an update to the Revisions to the Inpatient Prospective Payment System; Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF) for 2018; Provider-Based (PB) Determination; and more!
 

August 3, 2017
Medicare Insider

This week's note from the instructor discusses therapy codes, caps, modifiers, and the exception process.

August 1, 2017
Medicare Insider

This week's Medicare updates include an update to the 2018 Proposed Home Health Prospective Payment System Rate; ICD-10 Coding Revisions to National Coverage Determinations; Updated Editing of Always Therapy Services; and more!
 

July 27, 2017
Medicare Insider

This week's note from the instructor explores the important role of chronic care management in rural health. 

July 26, 2017
Medicare Insider

This week's Medicare updates include the Medicare Claims Processing Manual Chapter 15 Update; the Assistant Inspector General for Evaluation and Inspections Office testifies before congress; revision of the Quality Improvement Organization (QIO) Manual; and more!
 

July 20, 2017
Medicare Insider

This week's note from the instructor looks at understanding the OIG's Work Plan.

July 19, 2017
Medicare Insider

This week's Medicare updates include the 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule; the 2018 Medicare Physician Fee Schedule (MPFS) and Other Revisions to Part B / the Medicare Shared Savings Program Requirements and Medicare Diabetes Prevention Program proposed rule; the Federal Healthcare Fraud Takedown; and more!

July 13, 2017
Medicare Insider

This week's note from the instructor explains why a pre-service coverage analysis team is an essential part of a revenue integrity plan.

July 12, 2017
Medicare Insider

This week's Medicare updates include a revision to State of Operations Manual (SOM) Appendix PP for phase 2; suppression of G9678 Oncology care model monthly enhanced Oncology services; an OIG report on Part D plans; and more!
 

July 6, 2017
Medicare Insider

This week's note from the instructor discusses reporting revenue codes and HCPCS codes for rural health clinics. 

July 5, 2017
Medicare Insider

This week's Medicare updates include phase 2 of implementing FISS updates to accommodate section 603 of the Bipartisan Budget Act of 2015; new effective dates for Hepatitis B Virus screening programs; revisions to the End-Stage Renal Disease Prospective Payment System 2018 Proposed Rule; and more!

June 29, 2017
Medicare Insider

This week's note offers guidance on CPT E/M codes for new versus established patients and addresses OIG reports on E/M codes audits.

June 28, 2017
Medicare Insider

This week's Medicare updates include a Quality Payment Program proposed rule; new guidance for formatting plans of correction; clarification regarding Conditions for Coverage for End Stage Renal Disease facilities; and more!

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!