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Medicare Compliance & Reimbursement Alert

Fraud & Abuse:
See What’s in the Stark Law Revamp
Hint: Value-based care is the centerpiece of the proposal. If you've been on the edge of ... Read more
Don’t Miss AKS, CMP Updates in New Rule
Hint: Expect safe harbors that promote value and coordination. Many of the federal rollba... Read more
HIPAA Compliance:
Follow the Rules on Social Media Interactions or Pay the Price
Tip: Know how HIPAA impacts your practice social media. Medicare providers use social med... Read more
Social Media:
Encourage HIPAA-Friendly Social Media Policies
Tip: Know how HIPAA impacts your practice social media. Medicare providers use social med... Read more
Know the Dangers of Cloned Notes
Hint: Do not assume your EHR is flawless. There's no denying that the advent and adoption... Read more
Industry Note:
AIC Thresholds Increase in 2020
Plus: CMS extends QRP deadline for SNF and others. If you're filing an Administrative Law... Read more
Reader Question:
Know Definitions of ‘Chronic’ May Vary
Question: When should I code for an acute form of a condition as opposed to a chronic form... Read more
MAC Expert Reveals the Truth on 8 Medicare Myths
Hint: Non-par providers can still care for Medicare beneficiaries. Quite a few people bel... Read more
Quality Payment Program:
Test Your MIPS Savvy With These 10 Quick Questions
Hint: Performance Year and Payment Year are not the same. Even though the Quality Payment... Read more
E/M Coding:
Conquer Prolonged Service Woes With 3 Tactics
Tip: Document time appropriately. From time to time, providers' E/M face-to-face visits g... Read more
Clip And Save:
Recognize These 18 PHI Identifiers
Tip: Don't forget a URL can be PHI, too. It's critical that you know the HIPAA basics to ... Read more
Industry Note:
CMS Clamps Down on Nursing Home Fraud and Abuse
Nursing homes care for some of the most vulnerable patients in the U.S., and new policies ... Read more
Industry Note:
AHIMA Updates Its Cybersecurity Guidelines
The American Health Information Management Association (AHIMA) offers providers enhanced a... Read more
Industry Note:
Check Out OIG’s Revamped Fraud Risk Indicator
According to the feds, Medicare fraud is measured through False Claims Act (FCA) violation... Read more
Industry Note:
Know the Details on the Discharge Planning Final Rule
Medicare released another policy that interweaves interoperability with patient-centered i... Read more
Medicare Policy:
CMS Aims to Cut More Burdens with Another Rule
Flexibility is key to new policies. Medicare has pumped out an unusually long list of rul... Read more
Keep These Surgeon-Specific Modifiers on Standby
Know the nuances for coding and classifying additional surgeons. Operative reports aren't... Read more
Dates & Deadlines:
Register These Must-Knows As 2019 Winds Down
Tip: Expect HICNs to Reject Starting Jan. 1. If you're trying to keep your records straig... Read more
Industry Notes:
CMS Updates Dual Eligible Guidance On ABNs
Plus: Feds Charge 35 with genetic testing scheme. Don't miss the feds latest ABN change u... Read more
Reader Question:
Understand Both Your State Privacy Laws and HIPAA
Question: With all the new state laws going into effect to protect patients' privacy, we'r... Read more
Reader Question:
Review Time Rules for E/M Services
Question: I'm confused about coding E/M services by time. Do we have to document the exact... Read more
Fraud & Abuse:
Enforcement Reaches New Heights in September Takedowns
As fraud grows, the feds double down with bigger penalties. Medicare's stream of rollback... Read more
These 3 Things Will Impact Fraud and Abuse
CMS sends mixed messages about what to expect. Don't be fooled into a false sense of secu... Read more
CPT® 2020:
Review These Top CPT® 2020 Revisions
Know what's slated to take effect on January 1. Primary care remains a focus area for the... Read more
OCR Settles First ‘Right to Access’ Case
Practices should anticipate more enforcement on this issue. The feds have initiated many ... Read more
Industry Notes:
Don’t Wait Until the Deadline to Start Using Patients’ MBIs
Plus: Last call for MIPS 2018 targeted review requests. Hop on board the Medicare Benefic... Read more
Reader Question:
Pocket These Tips for Teaching Physician Services
Question: We currently have a medical student working with us at our clinic. In patient en... Read more
Quality Payment Program:
Feds Rework MIPS Policies Again For 2020
Hint: Category reweighting is on the horizon. The feds are pushing for less paperwork for... Read more
Medicare Policy:
Review 4 Care Management Proposals on the Table
Hint: MPFS offers CM changes, overhauls, and a new option. If care management services ar... Read more
2019 Data Security Incidents Are Pummeling Providers
Hint: Hackers are pushing healthcare's limits. The feds had a banner year in 2018, report... Read more
Test Your HIPAA Security Smarts With Q&A Set
Tip: Monitor and log your networks for irregularities. Familiarizing yourself with cyber ... Read more
Industry Notes:
CMS Rolls Out MFA for Online Provider Enrollment
Plus: CMS updates waivers and guidance for those impacted by Hurricane Dorian. Hackers co... Read more
Evaluation & Management:
CMS Cuts Blended E/M Rate in MPFS Proposal
The 2020 rule aims to fix other E/M issues, too. Recent evidence suggests that stakeholde... Read more
Check Out 5 Fee Schedule Takeaways
Hint: CMS is still deciding on Stark. If you're looking for a rundown of what's hot in th... Read more
CPT® 2021:
Expect 3-Prong Approach to E/M Down the Line
Summary details suggest more order to E/Ms in the future. CPT® plans to split E/M servic... Read more
New Health IT Pilot Program Uses Claims Data
CEHRT is at the center of this new policy. The Centers for Medicare & Medicaid Servic... Read more
Recovery Audit Contractors:
Discontinued Procedure Modifiers Find Spot on RAC’s To-Do List
Tip: Documentation will help clarify usage. Sometimes, you're forced to discontinue a pro... Read more
Clip And Save:
Use These Steps to Cut Down Your Chances of Fraud
Tip: Don't share your NPI with others. Though the Centers for Medicare & Medicaid Ser... Read more
Industry Notes:
QPP Hardship Exception Applications for PI Now Open
Plus: If approved, CMS will reweight the PI category. If you're struggling with meeting t... Read more
Know the Difference Between Fraud and Abuse
Hint: ‘Gang visits' aren't what you think. If you're thinking that all the Medicare rol... Read more
Are Your 99285 Claims in the Outlier Zone?
Use the latest benchmarking stats to see where your practice falls. If a majority of your... Read more
See If Your State Is in the Top Ranks
Tip: Measure your stats against outliers in your state. In addition to its overview of th... Read more
Tackle 99285 Questions With 3 Tips
Find out when 99285 is warranted — and when it's not. Whether you bill 99285 for every ... Read more
Policy Update:
MIPS Audits Are Now in Full Swing
Plan on keeping your MIPS data for six years or longer. If you were just prepping your Me... Read more
Reader Question:
How Do Different Payers’ Define Medical Necessity?
Question:  Recently, we had a few claims denied that really surprised both our clinic... Read more
MedPAC Proposal Aims to Nix ‘Incident To’
Hint: This could impact your bottom line. If your practice utilizes “incident-to” bil... Read more
See New Eye Fracture, Poison Codes Available Oct. 1
CMS offers new code options for pulmonary embolisms in 2020. Last month, the Centers for ... Read more
Clip and Save:
Review and Dispute MIPS 2018 Data With This Primer
Tip: Check your performance feedback ASAP. Right now, your practice is probably focused o... Read more
Reader Question:
Know How ‘Regular Hours’ Are Defined
Question: Our practice has decided to stay open this Labor Day, and we've let our pat... Read more
Industry Note:
Vendors and Partners Must Use MBIs, Too
Statistics shows that providers are doing a great job with the Medicare card transition. H... Read more
Industry Note:
MAC Offers New TPE Advice in Q-and-A Set
If you've got questions about the Targeted Probe and Educate (TPE) medical review program ... Read more
Industry Note:
ZIP Code Edit Leads to Hospice NOE Errors
A claims system glitch has been returning numerous Notices of Election (NOE) to hospices i... Read more
Industry Note:
Acupuncture May Be Covered By Medicare in the Near Future
If your patients suffer from lower back pain, you may be able to utilize acupuncture and g... Read more
Industry Note:
OCR Releases New Guidance on HIPAA and Health Plans
To better clarify patient data sharing between two separate health plans, the Department o... Read more
Industry Note:
ASPR-TRACIE Addresses Hurricane Season
The feds offer new advice and insight in the wake of the California earthquakes and the im... Read more
OIG Doubles Down on False Claims
Report highlights importance of medical necessity. If you've ever wondered whether the U.... Read more
Tackle Telemedicine Coding With 2 Top Tips
Know the rules on ‘face-to-face' care. Telemedicine has quickly emerged as a great opti... Read more
Master Addenda Requests With This Advice
Tip: Explain why changes are necessary to the documentation. When a coder receives a char... Read more
Reader Question:
Use ICD-10-CM Codes for Signs and Symptoms
Question: We have a coder who wants to hold charts when patients don't have definitiv... Read more
Industry Note:
MBI Usage Remains Steady
If you haven't started transitioning your practice from using Health Insurance Claims Numb... Read more
Industry Note:
CMS Uploads New IRF Appeals Program
Last summer, the Centers for Medicare and Medicaid Services (CMS) commenced a short-term v... Read more
Industry Note:
MAC Sees Uptick in Late Signature Issues
One Medicare Administrative Contractor (MAC) warns that late signatures may lead reviewers... Read more
Industry Note:
EHRA Urges Feds to Rein in EHR Mandates
Industry insiders believe the proposed interoperability rule's quicker-than-usual required... Read more
Reader Question:
Is the HIPAA Audit Program Gone for Good?
Question: With all the recent news on increased HIPAA enforcement, should we be worri... Read more
Match Addresses Exactly for Off-Campus Claims or Risk Denials
Tip: Review what's in PECOS as soon as possible. If you're already worried about denials,... Read more
Stay in the Loop with 5 Important CMS Updates
More documentation cutbacks are on the horizon. As the Centers for Medicare and Medicaid ... Read more
E/M Coding:
What’s on the Horizon for E/M in 2021? Find Out
Say farewell to 99201. Big changes are coming to outpatient evaluation and management (E/... Read more
Clip And Save:
Up Your Cyber Smarts With Password Savvy
Check out updated NIST guidelines for federal clarification. Even with the strongest secu... Read more
Reader Question:
Know the Coding Rules When the Patient Isn’t Present
Question: A patient's wife presented to talk about her husband's colonoscopy results and d... Read more
Industry Note:
Don’t Forget Zip Codes When Submitting Flu Vaccine Claims
Claims for services outlined and payable under the Medicare Physician Fee Schedule (MPFS),... Read more
Industry Note:
OIG Warns About Genetic Testing Fraud
If your Medicare patients call with questions about cheek swabs for tests that you never o... Read more
Industry Note:
MAC Cautions Physicians About Medical Necessity for Home Health
When referring Medicare beneficiaries for home health care, it's all in the details. In a ... Read more
Coding Quiz:
Test Your E/M Documentation Acumen
Hint: Take detailed notes to circumvent TPE reviews. You may think with the Centers for M... Read more
CMS Updates Hospital Co-Location Guidance
Draft argues for more detailed shared-space planning to protect patients. Sharing public ... Read more
Coding Quiz Answers:
Check Your Answers On Our E/M Documentation Quiz
Hint: Know the basic requirements for coding critical care. Once you've answered the quiz... Read more
Master ABNs with These 4 Tips
Hint: Don't forget to append the appropriate modifiers. Now and again, your practice may ... Read more
Reader Question:
Know These Q6 Facts for NP Claims
Question: Can we report a nurse practitioner's (NP) services to Medicare with a locum tene... Read more
Industry Note:
Feds Offer Date for Safe Harbors’ Proposed Rule
The feds have finally homed in on a release date for the long-promised revisions to safe h... Read more
Industry Note:
HHS Offers New HIPAA Fact Sheet on BAs’ Liability
If business associates (BAs) think that HIPAA compliance doesn't apply to them, they have ... Read more
Industry Note:
HHS-OIG Bids Levinson Adieu
The HHS Office of Inspector General (OIG) will be looking for a new head honcho, according... Read more
Industry Note:
New CMS Podcast Highlights CMMI Payment Models
If you need help understanding the plethora of payment models that have dropped over the l... Read more
Industry Note:
‘Pathways to Success’ ACO Application Process Opens June 11
If you want to apply to be an Accountable Care Organization (ACO) in the Medicare Shared S... Read more
CMS Bolsters Primary Care With New Payment Models
Feds offer big incentives, but expect big risks, too. Primary care policy often takes a b... Read more
Feds Substantially Reduce HIPAA CMP Annual Limits
Tip: Don't overlook your risk factors. In 2018, the feds set records with their HIPAA enf... Read more
Pocket This Primary Care First Breakdown
Hint: Medicare pay may be adjusted based on your performance. CMS continues to churn out ... Read more
Fraud and Abuse:
Case Illustrates the Importance of Compliant Telehealth Arrangements
Documentation backs up telemedicine claims. The convenience of offering clinical services... Read more
MACRA Coding Update:
CMS Issues Update on MIPS Patient Relationship Codes
Hint: The modifiers won't always be voluntary, CMS warns. Since MACRA mandated the Qualit... Read more
Industry Notes:
Feds Extend Comment Period on Interoperability Proposals
Hurry, before the window closes on June 3. Do you need more time to peruse the interopera... Read more
Are You Ready for a MIPS Audit?
Tip: Back up measures' submissions with documentation and dates. As CMS maintains a stead... Read more
Sidestep 5 High-Risk Behaviors That Heighten MIPS Scrutiny
Tip: Auto-population often leads to inaccuracy — and audit. Merit-Based Incentive Payme... Read more
Organize Your MIPS Files With this Audit Advice
Tip: Keep your EHR vendor's information handy, too. Whether you're a pro at Merit-Based I... Read more
Boost Documentation Capital With Z Codes
Tip: Check out miscellaneous options for treatments that don't fit into a category. Z cod... Read more
Know the 5 Different Contracts That Concern Privacy and Security
Hint: Factor cybersecurity into your BAAs. HIPAA compliance planning and training can hel... Read more
Industry Notes:
Measles Cases Soar Past 700 in the U.S.
Find out if your state is on the list. With the number of confirmed measles cases increas... Read more
CMS Finalizes Telehealth Expansion for Medicare Advantage
Cost-savings is at the heart of the final rule. CMS continues to reshape healthcare, ensu... Read more
Resolve Modifier 25 Troubles With This Expert Insight
Tip: Recognize the differences between modifiers' 25 and 57. Most Medicare providers see ... Read more
Pocket These Modifier 25 Essentials
Tip: Documentation must show medical necessity. Modifier 25 (Significant, separately iden... Read more
E/M Coding:
Test Your ROS Smarts With This Q & A
Tip: Thorough documentation helps determine the E/M level. When choosing the correct E/M ... Read more
Reader Question:
Ensure External Morbidity Codes Are Secondary
Question: In the interests of painting the most complete diagnosis picture possible, our c... Read more
Reader Question:
Know When It’s Ok to Write Off a Patient’s Bill
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Industry Note:
Review Your MIPS 2018 Performance Feedback
You can no longer submit 2018 Merit-Based Incentive Payment System (MIPS) data, bu... Read more
Industry Note:
CMS Drops Another Podcast
If you haven't heard, CMS is now offering policy highlights, thoughts, and ideas via podca... Read more
Industry Note:
MBI Usage Stays On Target
The majority of providers are successfully submitting Medicare claims with Medicare Benefi... Read more
Industry Note:
Patient Coordinator Pleads Guilty for HIPAA Violation
Under HIPAA, covered entities (CEs) are responsible for ensuring that their patients' prot... Read more
RACs Investigate SNF Consolidated Billing
Plus: OIG keeps this matter as an active Work Plan item. If you're confused about Medicar... Read more
Sidestep Consolidated Billing Blunders With These 3 Tips
Know the payment rules associated with SNF patients. Occasionally, Medicare providers see... Read more
Prepare For Consolidated Billing Situations With This Sample Contract
Expedite SNF coordination with an upfront agreement. If you find your practice is coordin... Read more
Remember the 5 Levels of the Medicare Appeals Process
Tip: First, try reopening a claim before you appeal. If you're fuzzy on how to appeal a d... Read more
Put Staff HIPAA Training on the Top of Your To-Do List
Tip: Make sure your employees know what constitutes PHI. HIPAA planning can seem like a h... Read more
Reader Question:
Understand How Location Impacts RVUs
Question: What is the “conversion factor,” and how does it affect Medicare payment? A... Read more
Industry Note:
CMS Commences New HIPAA Audit Program
Plus: The MAC Satisfaction Indicator survey is back. If you weren't keen on the HIPAA pha... Read more
Part B Statistics:
New CBR Targets Family Practice and E/M Office Visits
Find out where your code usage fits into the stats. If you worry that your claims aren't ... Read more
See If Your State Topped the National Averages
Plus: E/M services still on TPE checklists. With Medicare claims reviews coming at you fr... Read more
E/M Coding:
Boost Claims Accuracy With CBR Insights
Tip: Benchmark your stats against those of other specialists to fix E/M faults. Denial ra... Read more
HIPAA Enforcement Reached New Heights in 2018
Hint: Breaches drew huge penalties for risk assessment fails. If 2018 taught providers an... Read more
Reader Question:
Master New Physician Billing With These Tips
Question: A new physician started at our practice, but she hasn't received her insurance c... Read more
Industry Note:
Be Part of the PI Measures Decision-Making
CMS wants to hear how you think the Promoting Interoperability (PI) program should proceed... Read more
Industry Note:
Novitas Advises on Uptick in Resubmissions Denials
Corrections' requests for resubmitted claims are becoming a problem, one Medicare Administ... Read more
Industry Note:
AMA Gets in on States’ Lawsuit Against Feds Over Title X Gag Rule
On Feb. 22, HHS issued a final rule in the Federal Register that upends the Title X family... Read more
Twin Proposals Address Health Data-Sharing Flaws
CMS may revise some CoPs to accommodate the proposed rule. Over the last year, CMS has be... Read more
Information Blocking:
Cures Act Proposals Offer 7 Data-Blocking Exceptions
The costs of information sharing may factor into future policymaking. The healthcare indu... Read more
Fortify 3-Year Rule Smarts with Expert Tips
Sidestep compliance conundrums with this advice. Before you can choose the right E/M code... Read more
Reader Question:
Spot Consultation Conundrums With Office Versus Inpatient Expertise
Question: What is the difference between an office consultation and an inpatient consultat... Read more
Industry Note:
MIPS 2018 Submission Deadline Is Fast Approaching
If you are an eligible clinician and required to participate in the Merit-Based Incentive ... Read more
Industry Note:
Sign Up to Exchange ADR Letters Via esMD
CMS wants to make your practice communications easier and more efficient, a new release su... Read more
Industry Note:
CMS Goes Mainstream with New Podcast
If you prefer to listen to the news via podcast, then you are in for a treat. CMS recently... Read more
Industry Note:
Aging Boomers Projected to Impact Medicare Spending Significantly
Federal healthcare spending will add a hefty chunk to the Gross Domestic Product (GDP), a ... Read more
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