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!

June 14, 2017
Medicare Insider

This week’s Medicare updates include the elimination of routine reviews including documentation compliance reviews and instituting three medical reviews; new guidance for outpatient facility claims; standardization of demand letter language; and more!

June 14, 2017
Medicare Insider

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

June 7, 2017
Medicare Insider

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

June 6, 2017
Medicare Insider

This week’s Medicare updates include the July 2017 update to the Ambulatory Surgical Center Payment System; the Spring 2017 Semiannual Report to Congress; a new Targeted Probe and Educate Pilot; and more!

May 31, 2017
Medicare Insider

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

May 30, 2017
Medicare Insider

This week’s Medicare updates include National Coverage Analysis for Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease; ICD-10 coding revisions to National Coverage Determinations; the July 2017 OPPS quarterly update; and more!

May 24, 2017
Medicare Insider

This week's note discusses the order and certification requirement for critical access hospitals (CAH), including the proposal in the FY 2018 IPPS proposed rule to reprioritize the review of CAH inpatient admissions.

May 23, 2017
Medicare Insider

This week’s Medicare updates include a clarification of medical reviews of hospital claims for Part A payment, two new “K” codes for therapeutic continuous glucose monitors, The July 2017 quarterly HCPCS Drug/Biologicals code change update; and more!

May 17, 2017
Medicare Insider

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

May 16, 2017
Medicare Insider

This week’s Medicare updates include new CLIA waved tests, changes to the payment policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly “Locum Tenens Arrangements”), implementation of modifier -CG for Type of Bill 72x, and more!

May 11, 2017
Medicare Insider

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

May 8, 2017
Medicare Insider

This week’s Medicare updates include the April 2017 Medicare Quarterly Provider Compliance Newsletter, scribe services signature requirements, outlier limitation on OPPS Community Mental Health Centers Services, and more!

May 2, 2017
Medicare Insider

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

May 2, 2017
Medicare Insider

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

April 26, 2017
Medicare Insider

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

April 25, 2017
Medicare Insider

This week’s Medicare updates includes new information on payment for moderate sedation services, influenza virus vaccine code implementation, new K codes for therapeutic continuous glucose monitors, and more!

April 18, 2017
Medicare Insider

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

April 11, 2017
Medicare Insider

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

April 4, 2017
Medicare Insider

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

April 3, 2017
Medicare Insider

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

March 28, 2017
Medicare Insider

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

March 27, 2017
Medicare Insider

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

March 21, 2017
Medicare Insider

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

March 21, 2017
Medicare Insider

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

March 14, 2017
Medicare Insider

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

March 14, 2017
Medicare Insider

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

March 9, 2017
Medicare Insider

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

March 7, 2017
Medicare Insider

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

March 2, 2017
Medicare Insider

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

March 1, 2017
Medicare Insider

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

February 21, 2017
Medicare Insider

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

February 21, 2017
Medicare Insider

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

February 13, 2017
Medicare Insider

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

February 13, 2017
Medicare Insider

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

February 8, 2017
Medicare Insider

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

February 7, 2017
Medicare Insider

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

February 1, 2017
Medicare Insider

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

January 31, 2017
Medicare Insider

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

January 23, 2017
Medicare Insider

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

January 23, 2017
Medicare Insider

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

January 18, 2017
Medicare Insider

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

January 17, 2017
Medicare Insider

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

January 11, 2017
Medicare Insider

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

January 4, 2017
Medicare Insider

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

January 4, 2017
Medicare Insider

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

December 28, 2016
Medicare Insider

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

December 28, 2016
Medicare Insider

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

December 20, 2016
Medicare Insider

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

December 20, 2016
Medicare Insider

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

December 13, 2016
Medicare Insider

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

December 13, 2016
Medicare Insider

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