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.

July 8, 2020
Medicare Insider

This week’s Medicare updates include the release of the 2021 ICD-10-CM code set files, a proposed decision memo regarding expanded coverage of a transcatheter mitral valve repair procedure, revisions to the July 2020 OPPS update, and more!

July 2, 2020
Medicare Insider

This week's note from the instructor examines ways compliance officers can help mitigate compliance risks within the revenue cycle. 

July 1, 2020
Medicare Insider

This week’s Medicare updates include the publication of a new ABN form, the release of the 2021 Home Health Prospective Payment System proposed rule, new additions to the OIG Work Plan, and more! 

June 25, 2020
Medicare Insider

This week's note from the instructor examines places where new guidance from CMS on billing for telemedicine during the public health emergency falls short and what hospitals should do to ensure compliance with these billing policies. 

June 24, 2020
Medicare Insider

This week’s Medicare updates include new additions to the COVID-19 Medicare billing FAQs, information on billing for clinician services for diagnostic lab tests, the quarterly update to the ambulatory surgical center payment system, and more! 

June 18, 2020
Medicare Insider

This week's note from the instructor discusses the supervision requirements for certain outpatient services and changes to those requirements during the public health emergency. 

June 10, 2020
Medicare Insider

This week’s Medicare updates include revisions to billing guidance for using the CR modifier and DR condition code, a table listing changes to CMS Innovation Center models, the July 2020 update to the OPPS, and more!

June 4, 2020
Medicare Insider

This week's note from the instructor celebrates NAHRI's Revenue Integrity Week by featuring two revenue integrity case studies on managing the financial impact of COVID-19. 

June 3, 2020
Medicare Insider

This week’s Medicare updates include new information on the Part D Senior Savings Model, updates to the FAQs on fee-for-service billing during the COVID-19 public health emergency, the release of the 2021 ICD-10-PCS code set, and more!

May 28, 2020
Medicare Insider

This week's note from the instructor looks at billing and payment policies for swing beds during the COVID-19 pandemic. 

May 27, 2020
Medicare Insider

This week’s Medicare updates include new pricing information for COVID-19 testing, a final rule for Medicare Advantage and Part D plans, updates to the OIG Work Plan, and more!

May 21, 2020
Medicare Insider

This week's note from the instructor takes a closer look at certain IPPS proposals, including one that could change the method CMS uses to update MS-DRG payment rates.

May 20, 2020
Medicare Insider

This week’s Medicare updates include the 2021 Inpatient Prospective Payment System proposed rule, an FAQ on COVID-19 price transparency regulations, a new toolkit for nursing homes managing COVID-19 cases, and more!

May 14, 2020
Medicare Insider

This note from the instructor looks at some of the major provisions in the Inpatient Prospective Payment System (IPPS) proposed rule, including the shortened delay in effective period for the final rule.

May 13, 2020
Medicare Insider

This week’s Medicare updates include clarifications on interstate license compacts, a new national coverage determination on acupuncture, a list of hospital outpatient therapeutic services with supervision level changes, and more!

May 7, 2020
Medicare Insider

This week's note from the instructor examines new regulatory relief for hospitals regarding outpatient services and telehealth originating site services provided to patients at alternate locations, including their homes.

April 30, 2020
Medicare Insider

This week's note from the instructor looks at the timing of the prior authorization program implementation in light of the current COVID-19 public health emergency.

April 29, 2020
Medicare Insider

This week’s Medicare updates include recommendations on re-opening facilities for non-emergent, non-COVID-19 care, new guidelines for nursing homes on notification of confirmed or suspected COVID-19 cases, a notice about the Accelerated and Advance Payment Programs, and more!

April 23, 2020
Medicare Insider

This week's note from the instructor reviews new guidance from CMS on policies for rural health clinics during the COVID-19 pandemic. 

April 22, 2020
Medicare Insider

This week’s Medicare updates include guidance for long-term care facilities on resident transfers during the COVID-19 pandemic, increased payment for certain COVID-19 tests, the FY 2021 inpatient rehab facility prospective payment system proposed rule, and more!

April 16, 2020
Medicare Insider

This week's note from the instructor reviews regulatory changes for rural health clinics during the public health emergency. 

April 15, 2020
Medicare Insider

This week’s Medicare updates include proposed rules for the inpatient psychiatric facility, skilled nursing facility, and hospice prospective payment systems; updated guidance on infection control for multiple provider types; additional waivers to relax regulatory requirements during the pandemic, and more!

April 9, 2020
Medicare Insider

This week's note from the instructor walks through the various provisions of CMS' interim final rule on policy and regulatory changes during the COVID-19 pandemic.

April 8, 2020
Medicare Insider

This week’s Medicare updates include revised guidance on billing for professional telehealth services during the public health emergency, updated provider-specific fact sheets on waivers and flexibilities during the COVID-19 pandemic, revised guidance on EMTALA compliance for COVID-19, and more! 

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.