Medicare Compliance & Reimbursement Alert

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