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Medicare Compliance & Reimbursement Alert

CMS Offers More Options With 3 Payment Models
Hint: Risks may outweigh the advantages. CMS continues to churn out notices, proposals, a... Read more
National Correct Coding Initiative:
Know These New PTP Edit Pairs
CCI 2019 adds biopsy, care management, and psych test codes to the list. With 45,727 addi... Read more
Master Concurrent Care With These Expert Tips
Documentation is key to successful submissions. Concurrent care of a patient is complicat... Read more
Reader Question:
Avoid Cloned Notes’ Scenarios With Expanded Documentation
Question: Our practice lists the chief complaint for all follow-up visits using just “f/... Read more
Clip And Save:
Plan For Accidents With This Q-and-A
Circumvent practice chaos with risk planning. Office mishaps are common, but are your pra... Read more
Industry Note:
Remember, There Are No ‘Os’ In MBIs
CMS wants to remind practices that the new Medicare Beneficiary Identifiers (MBI) do not c... Read more
Industry Note:
New MAC Offerings Advise on Transitional and Chronic Care
Medicare Administrative Contractor (MAC) Palmetto GBA has uploaded a series of modules to ... Read more
Industry Note:
OIG Adds Podiatry to Its List of Part B Audits
The HHS Office of Inspector General (OIG) added another Part B item to its Work Plan. Tho... Read more
Industry Note:
EHR Vendor Lands $57.25 Million Penalty For False Claims
As providers know, not all EHR vendors are the same. Most are on the up-and-up, but it's s... Read more
Fraud And Abuse:
Physician Fraudsters Are On Feds’ Target List
Home health, opioid fraud are top DOJ targets.  Federal enforcement agencies got rig... Read more
Apply This Expert Input To Factor Your Audit Odds
Check Medicare utilization data by specialty to see where you fit in. Medicare audits are... Read more
Put These 5 Focus Areas On Your Audit Radar
E/M coding remains a hot issue for Medicare claims auditors. Medicare coders should get t... Read more
Conduct Self-Audits Adeptly With This Expert Advice
Hint: Watch coding trends to determine audit frequency. As the feds scrutinize Medicare c... Read more
Bolster Your Practice IT With New HHS Insight
The size and scope of your Medicare practice will impact your IT security. There's no de... Read more
Industry News:
MGMA Poll Reveals Many MIPS Providers Aren’t Making Ends Meet
Statistics suggest that practices are struggling to make a profit based on their Merit-Bas... Read more
Industry News:
New Medicare App Ups The Ante On eHealth
Last week, CMS followed through on its Blue Button 2.0 promises from last year to improve ... Read more
Industry News:
CMS Offers New Medicare Enrollment App For Physicians and NPPs
If you thought the old Medicare Enrollment Application was burdensome, you're in for a tre... Read more
Industry News:
Pick The Right ADR Submission Button, MAC Warns
Home health agencies served by HHH Medicare Administrative Contractor (MAC) CGS should be ... Read more
Medicare Policy:
ACOs: ‘Pathways to Success’ Reshapes MSSP
Get ready to transition over to the new program ASAP.  Accountable Care Organization... Read more
Review Key MSSP Final Rule Updates
ACOs must notify beneficiaries in writing about MSSP participation. In an effort to boost... Read more
Targeted Probe And Educate:
Watch Your Subsequent Care Coding, Medical Reviews Suggest
Hint: Incorrect coding tops the denial reasons for these codes. Billing subsequent hospit... Read more
E/M Coding:
Master Subsequent Care Coding with 3 Expert Tips
Hint: Avoid consultation codes for Medicare. If subsequent hospital care coding has you s... Read more
Industry Note:
CMS Advises on New LCD Rules
According to MLN Matters 10901, CMS used recent Medicare Physician Fee Schedule (MPFS) fee... Read more
Industry Note:
Same Medicare Programs, New Look
CMS updated the look of its Promoting Interoperability (PI) programs' and Quality Measurem... Read more
Industry Note:
New Medicare Numbers Are Already the Norm, CMS Says
If you're not yet using the new Medicare Beneficiary Identifier (MBI) numbers contained on... Read more
OIG Targets Opioid Fraudsters in New Report
Telehealth misuse is now on the agency's radar screen. Over the last year, the feds have ... Read more
Modifier 59 Abuses Lead to $12.5 Million Settlement
Improper unbundling lands healthcare organization in hot water. Now, that you've aced all... Read more
Analyze Your Denials to Improve Your Appeals Odds
Tip: Request a peer review if necessary. Whether you love a good mystery or you've always... Read more
Control Cyber Threats with This Expert Advice
Hint: There's more to a risk analysis than an EHR check-up. If you're going over your 201... Read more
Industry Note:
CMS Transitions to New QPP Data Management System
Plus: Heed new MAC guidance on MBIs. The window is now open for eligible clinicians to su... Read more