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Medicare Compliance & Reimbursement Alert

Reimbursement:
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
Compliance:
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
Compliance:
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
Cybersecurity:
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
Reimbursement:
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
Enforcement:
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
Compliance:
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
Appeals:
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
HIPAA:
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