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Medicare Compliance & Reimbursement Alert

See What's at the Heart of FY 2018 CERT Report
Improper payment rate is on the decline, but mistakes are still in the billions. If you'r... Read more
Inadequate Notes Account for More Than Half of Improper Payments
Lack of medical necessity and lax coding round out the top 3 reasons. For FY 2018, CMS un... Read more
CERT Appeals:
When CERT Comes Knocking, Make Sure to Answer
Tip: Encrypt your emailed documentation per HIPAA, CERT contractor says. Unless you're on... Read more
Dates & Deadlines:
Pocket This List of 3 Critical Medicare Dates
Note the MIPS 2018 submissions vary according to how you submit measures. As the year com... Read more
Industry Note:
Prepare for New Part D Opioid-Prescribing Policies in 2019
As the opioid epidemic continues to plague the nation, CMS issued new guidelines for Part ... Read more
Industry Note:
Overlapping Hospice Claims Rejections May Be Errors
Beware a new payment glitch hitting hospice claims. “Hospice claims are incorrectly reje... Read more
Industry Note:
HHS Releases CHPL Data Challenge Winners
With the 2015 Edition Certified EHR Technology (CEHRT) now a requirement for eligible clin... Read more
Industry Note:
Review Rate Of Healthcare Spending
Healthcare spending continues its slow and steady growth. “Overall national health spend... Read more
Reader Question:
Know the Facts on Workers' Comp, Medicare Claims
Question: A 66-year-old patient presented to the emergency department (ED) after falling o... Read more
Reader Question:
OCR Proposes RFI on HIPAA Privacy Rule
In an effort to appease calls from the healthcare community to lessen the restraints of HI... Read more
Recovery Audit Contractors:
RACs Ratchet Up Modifier 57 Scrutiny
Review CPT® and CMS guidance for best results. Modifiers can help you explain your servi... Read more
Avert Modifier 57 Tangles with Global Surgery Distinctions
Understand the specifications for 10-day versus 90-day. The CMS Global Surgery Booklet is... Read more
Expect More Changes in 2019 for QPP's Promoting Interoperability
It might be time to revisit that EHR upgrade. If you thought the regulation merry-go-roun... Read more
Review This Gift-Giving Advice to Avoid Violations
Tip: Update your practice holiday gift guidelines to avoid AKS and Stark snafus. For many... Read more
Industry Note:
Medicare Wraps Up MBI Wave 6
Medicare has finished mailing new MBI-based Medicare cards to Medicare beneficiaries who l... Read more
Industry Note:
Apply for a MIPS Hardship Exception Before Dec. 31 Deadline
If you're struggling to meet the demands of the Merit-Based Incentive Payment System (... Read more
Industry Note:
Top Claims Issue for MAC — Too Many Claims Under Medical Review
If you're wondering what's taking your claim so long to process, it may be stuck in a clai... Read more
Reader Question:
Nip Identity Theft in the Bud With Proper PHI Disposal
Question: Our primary care practice is relocating to another office with more space, and w... Read more
Get Ready for More MIPS Revamps in 2019
CMS cuts back on tech measures, but flexibility is lost in the process. The last year of ... Read more
Check Out What's New in Virtual Care for 2019
New federal rules put telemedicine front and center. As technology takes healthcare in di... Read more
Revenue Booster:
Review This Q & A on Collecting for 5 Basic Services
Tip: Know the rules on NPP prolonged service codes. As costs continue to rise, it's essen... Read more
Industry Note:
Institutional Providers See $17 Increase for Medicare Enrollment Fee in 2019
If you thought $569 was a hefty application fee for Medicare enrollment for institutional ... Read more
Industry Note:
Don't Panic — OCR Updated Phase 2 HIPAA Audit Details
With little fanfare and no release, the HHS Office for Civil Rights (OCR) updated its Phas... Read more
Industry Note:
Anthem's HIPAA Settlement With OCR Biggest in History
As 2014 ended and 2015 began, private payer, Anthem Inc., suffered the biggest HIPAA viola... Read more
E/M Policy:
CMS Staggers Proposed E/M Changes in MPFS Rollout
Expect small E/M updates from 2019 through 2021, says MPFS. If you thought CMS would foll... Read more
See What's Ahead for E/M Payment in CY 2021
Level 5 codes will keep their higher payouts. For most providers, E/M visits make up a su... Read more
Master Modifier 24 With This Expert Advice
Tip: Review global surgery guidance for best results. Occasionally, a physician performs ... Read more
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Beef Up Your Medical Device Incident Response Plan
Tip: Keep medical devices off the network. Large-scale attacks like WannaCry and Petya th... Read more
Industry Note:
Feds Keep a Steady Focus on Opioid Fraud and Abuse
This past summer, the Department of Justice (DOJ) added a Strike Force team in Philadelphi... Read more
Industry Note:
Add This New Flu Vaccine to Your Code List
This year, you'll need to add 90689 (Influenza virus vaccine, quadrivalent (IIV4), inactiv... Read more
Industry Note:
CMS Offers Overview on QPP Year 3 Final Rule
If you're confused about the Quality Payment Program (QPP) Year 3 and all that entails, CM... Read more
Reader Question:
Master ABNs With G Modifiers
Question:  I'm filing a claim that includes an advance beneficiary notice (ABN) for a... Read more
CMS Revises LCD Guidelines
Medicare updates remove codes from LCDs. In an effort to streamline more of its processes... Read more
Revenue Booster:
Cut Down on Denials with This Handy Primer
Hint: Precise documentation leads to fewer claims issues. If your practice is spending pr... Read more
Review These Common Reasons for Claim Denials
Hint: Review code guidelines to back up claims. If Medicare denials are piling up at your... Read more
Keep Auditors at Bay With This Overpayment Advice
If Medicare overpaid you, send the extra cash back — ASAP. Consider this nightmare scen... Read more
Some States' Privacy Provisions Go Beyond Federal Rules
Check your state's rules to ensure compliance. The HHS Office for Civil Rights (OCR) defi... Read more
Industry Notes:
MBI Issues Are Already an OIG Target As Wave 7 Starts
Plus: Clinicians receive long prison sentences for Medicare fraud. CMS began its Medicare... Read more
CMS Plows Ahead With More Regulatory Reform
Recent proposal offers more burden-reducing shake-ups. There's no denying that Medicare p... Read more
Clamp Down On Claim Denials With This Signature Know-How
Tip: Send additional notes to bolster your claims. CPT® and ICD-10 codes are essential r... Read more
Risk Management:
There's More Than Just Lost PHI at Stake with a Data Breach
Write up an incident response plan today to avoid problems later on. Data security remain... Read more
Industry Note:
MAC Advises Providers — Send CERT Documentation ASAP
If you've received a documentation request for a follow-up due to a comprehensive error ra... Read more
Industry Note:
Watch for MBIs on Remittance Advice
Starting in October 2018, new Medicare Beneficiary Identifiers (MBIs) will be returned on ... Read more
Industry Note:
CMS Further Clarifies Modifier GT Usage
Last year, CMS eliminated modifier GT (Via interactive audio and video telecommunication s... Read more
Industry Note:
See How Your State's Quality Stats Stack Up With New AHRQ Details
If you're interested in finding out how your state is doing in the quality performance are... Read more
Industry Note:
MIPS 2017 Targeted Review Deadline Now Oct. 15
If you aren't satisfied with your Merit-Based Incentive Payment Systems (MIPS) performance... Read more
Industry Note:
HHS Updates Hurricane Resources For Providers
If you are struggling in the aftermath of the recent hurricane, HHS wants to help. The HH... Read more
Part B Reimbursement:
One MAC Eases Up on Some NPP E/M Service Rules
NGS Medicare changes claim filing process for NPs, PAs. As CMS continues to chip away at ... Read more
Test Your Modifier Smarts with These 5 Coding Conundrums
Hint: Documentation is key to utilize modifier 22. The appropriate use of modifiers can m... Read more
Disaster Coding:
Take Control of Your Catastrophe Claims
Tip: Some Medicare Conditions of Participation are waived with an 1135 waiver. When a nat... Read more
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Review New ICD-10 Advice on Hurricanes
Tip: Look to the 7th digit for injury clarification after a flood. If you're worried abou... Read more
Industry Notes:
Know These Flu-Season Basics to Sidestep the Sniffles
Plus: Michigan podiatrist gets tripped up with false claims conviction. The 2018-2019 flu... Read more
MSSP Proposals Aim to Raise the Bar on ACOs
Hint: Expect reporting to decrease while financial risks increase. The Medicare Shared Sa... Read more
Review 5 Major Changes in the MSSP Proposed Rule
Hint: CMS wants ACOs to ramp up their risks. If you're considering joining an Accountable... Read more
Hospices May Be Next on the Feds' Target List
Prepare for these actions focused on GIP, nursing facility patients, and more. The OIG ha... Read more
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Review Your State's Rules on Social Media and Medicine
Sidestep social media issues related to patients to keep your license intact. Social medi... Read more
Industry Note:
Do You Have Clinical Concerns? CMS Wants to Hear About Them
Practicing medicine can be a solitary profession with little time to discuss interesting s... Read more
Industry Note:
Don't Miss the Due Date for MIPS Exceptions
If your practice was impacted by disaster this year, you can still submit a hardship appli... Read more
Industry Note:
Know this Medicare Deadline Loophole
If you run behind on submitting your documentation for a claim under medical review, you m... Read more
Industry Note:
Family Practitioner Gets 5 Years in Prison for False Claims
A Saratoga, California physician pretended that she didn't understand how the federal heal... Read more
Reader Question:
Master CCI Edits with Unlikely, Exclusive Expertise
Question: The Correct Coding Initiative (CCI) is an enigma to me; I have a lot of trouble ... Read more
CMS Moves Virtual Health Forward
Plus: See more options for physicians as care goes online. The reduction of physicians' a... Read more
Sort Out EOB FAQs with These 5 Tips
Reminder: The EOB is not a bill. More often than not, patients receive their explanation ... Read more
Fraud And Abuse:
Millions Made By Whistleblowers Willing to Take Down Fraudsters
Plus: Qui tam law firms reach out to employees. If compliance isn't your strong suit, you... Read more
Master Breach Notification Basics with this Handy Cheat Sheet
If HHS protocols were used and PHI was not lost, it may not be a breach. Practices often ... Read more
Industry Note:
Have a Plan in Mind for the Disposal of Your Mobile Devices
Mobile devices are a popular and necessary means to delivery efficient care nowadays. Unfo... Read more
Industry Note:
Keep Revalidation Information Safe from Cyber Attack
HIPAA requires that practices safeguard their patients' protected health information (PHI)... Read more
Industry Note:
Are HIPAA Changes Around the Bend? Find Out
HIPAA compliance is essential to protect patients' privacy. However, some industry insider... Read more
Reader Question:
Keep On Top of When Codes Become Invalid
Question: We recently learned that if the procedure code was invalid on the date of servic... Read more
CMS Charges Ahead with Pro-Health IT Proposals
Expect eased requirements in next year's plans. If you're still figuring out how to balan... Read more
Promoting Interoperability Moves Front and Center
MPFS suggests more technical overhauls ahead for MIPS. Over the last year, an abundance o... Read more
Specialty May Determine Pay Gains with CY 2019 MPFS Proposal
Hint: Suggested E/M documentation changes could balance shortcomings. If a big part of yo... Read more
Revenue Booster:
Report APPs' Services Correctly to Maximize Reimbursement
Submit your advanced practice provider's services on every claim. Many specialties utiliz... Read more
Industry Notes:
Know These Tax Rate Changes for Traveling Staff
Plus: New Patients Over Paperwork newsletter looks at SNF payment system. If you don't pa... Read more
CMS Offers Up E/M Surprises in MPFS 2019 Proposal
All roads lead to burden reductions. As the feds maintain a steady focus on regulatory re... Read more
Scope Out These Proposed Medicare Fee Schedule High Points
Health IT permeates suggested policy changes heading into 2019. Across the board, the Med... Read more
E/M Payment:
Will Your Bottom Line Suffer If 99211 and 99215 Pay the Same Amount?
New proposals will hit some specialists hard, CMS statistics suggest. Due to overwhelming... Read more
See Post-Procedural Infection Code Options Debuting Oct. 1
More than 300 additions are on the 2019 diagnosis code slate. With 320 new diagnosis code... Read more
Review this HIPAA Violation and Penalty Primer
Tier 2 fines can levy a hefty penalty, recent case shows. Even if your practice aces HIPA... Read more
Industry Notes:
OIG Plans to Target MA Claims
Are you seeing an uptick in your Medicare Advantage (MA) denials? This might be the reason... Read more
Industry Note:
Home Health Rule Asks for Feedback on Interoperability
The CY 2019 home health proposed rule from CMS hit the streets on July 2, and the agency w... Read more
Industry Note:
Common Rule Updates Delayed ... Again
As the feds continue to downsize administrative burdens, HIPAA's “Common Rule” languag... Read more
Part B Statistics:
Measure Your Critical Care Numbers Against Other Providers'
See whether your E/M claims are on track. Medical necessity determines whether a service ... Read more
Review These Critical Care Service Examples
Tip: Both the illness and treatment must fit into Medicare's parameters. With critical ca... Read more
E/M Coding:
Bolster Your Critical Care Claims with Rock-Solid Notes
Hint: Time factors heavily in determining critical care billing. Although it may not happ... Read more
Are Your State's Critical Care Stats Above Average? Find Out
Warning: Critical care is on most MACs' Targeted Probe and Educate active lists. Benchmar... Read more
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Handy OCR Tool Helps Providers with PHI Quandaries in an Emergency
Follow these three rules to ensure HIPAA compliance. Patient safety comes first in an eme... Read more
Industry Note:
CMS Wants Your Feedback on a Stark Law Revamp
Last month, CMS published a Request For Information (RFI) on the physician self-referral l... Read more
Industry Note:
Avoid Diagnosis Code Debacles on the CMS-1500 or Risk Denials
Make sure you double-check line 21 on your CMS-1500 before you send Medicare your claims, ... Read more
Industry Note:
Use the New Medicare Beneficiary Identifiers ASAP
Now that your patients are getting their Medicare Beneficiary Identifier (MBI) numbers, yo... Read more
Industry Note:
Senior Fraud Patrol Recoups Millions for CMS
The Senior Medicare Patrol program continues to go strong, with the HHS Office of Inspecto... Read more
Industry Note:
Figure Out 2019 Part B Pay from Updated MIPS Performance Data
If you're curious about what your Medicare pay will amount to in 2019, CMS has updated eli... Read more
Do You Know OIG's Mid-Year Targets? Find Out
Feds hone in on urine tests, PT, and cardiac device recalls. OIG continues to hammer away... Read more
Stay on Top of These Upcoming CMS Deadlines
Applications and assessments may require mid-year maintenance. The first of the year usua... Read more
Safeguard Practice Property to Avoid Theft-Related Violations
Put protocols in place that make HIPAA security a priority. Accidental disclosures, priva... Read more
Boost Your Bottom Line with Low-Cost HIPAA Protections
Tip: Organize your office space and interiors to thwart break-ins. It's important to keep... Read more
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Know the 5 Facts That Impact All New Medicare Providers
Hint: Understand the rules for non-participating providers. Learning all there is to know... Read more
Industry Note:
CDC Releases Final FY 2019 ICD-10-CM Updates
Medicare providers will have lots of new options in their coding wheelhouse starting on Oc... Read more
Industry Note:
Gun Violence, Opioid Epidemic are the Hot Topics at AMA Annual Meeting
The nation's top physicians' group, the American Medical Association (AMA), encouraged act... Read more
Industry Note:
OIG Updates the Work Plan with 8 New Items
Medicare Advantage denials are among the hot topics the HHS Office of Inspector General ad... Read more
Industry Note:
Use CMS-855O Form for Unlicensed Residents ASAP
CMS wants to streamline provider enrollment for unlicensed residents in another effort to ... Read more
Reader Question:
Check MAC Rules for Non-Reimbursable Postoperative Visit Submissions
Question: For a postoperative, related evaluation and management (E/M) visit within the gl... Read more
Fraud & Abuse:
Watch Your Lab Referrals and Claims or Pay the Price
Fraud enforcements bring hefty fines - and prison. Unlawful lab referrals and unnecessary... Read more
Why Is Lab Work on the OIG Hit List?
The feds are reviewing the top 25 most requested lab tests, new report says. Clinical tes... Read more
Master the Big 3 to Sidestep Medicare Fraud Violations
'Knowing' means something entirely different to federal law enforcement. Providers and th... Read more
Revenue Booster:
Beef Up Your Bottom Line with this Incident-To FAQ
Pinpoint exactly what 'direct supervision' means. Billing your services incident-to allow... Read more
Industry Note:
Verma Weighs in on 2017 QPP Results
Plus: States respond to Anthem's controversial ED policy. Despite statistics that show re... Read more
Industry Note:
Missouri Lawmakers Take Action
On May 18, Missouri state legislators approved a law barring insurers from denying emergen... Read more
Follow This Expert Advice on Advanced APMs
The rewards can be great with APMs, but so can the risks. Most eligible clinicians (ECs) ... Read more
Weigh the Risks of an Advanced APM with this Checklist
Tip: Transitions may require more elaborate technical equipment. There are many things to... Read more
Utilize This MAC's Top 2018 Denial Reasons for Clean Claims
Hint: Keep on top of annual code revisions to avoid returns. Is your practice seeing more... Read more
Master Mobile Device Management with These Tips
Set up HIPAA-compliant protocols now to avoid problems later. Nowadays, you must take the... Read more
Industry Note:
CMS Offers New Medicare Card Project FAQ and MBI Guidance
Last month, CMS started sending out new Medicare cards to its beneficiaries. As with any n... Read more
Industry Note:
House Proposes 57 Bills to Combat Opioid Abuse
As the death toll continues to rise from the fallout of the national battle against opioid... Read more
Industry Note:
New MIPS Updates Reflect 'Promoting Interoperability' Rebrand
CMS revised all of its Quality Payment Program (QPP) materials on May 11 to reflect the re... Read more
Industry Note:
CMS Pushes Rural Medicine into the Spotlight
Rural providers don't necessarily have the same tools to practice medicine that urban clin... Read more
Industry Note:
Check Your GDPR Compliance Protocols
If your practice engages in medical research, you may want to review privacy guidelines fo... Read more
Reader Question:
Timely Claims Get Paid — Late Claims Do Not
Question: We had a problem with a claim and didn't get it filed with Medicare until over a... Read more
CMS Introduces 'Promoting Interoperability' as MU Rebrand
Burdens are reduced, but providers face penalties for not sharing data with patients. If ... Read more
Get the Facts on Audits from the Experts
If someone stole your NPI and is using it on claims, ZPIC or UPIC can help. With so many ... Read more
Compare Your Opioid Prescription Stats Against Your Peers
Hint: Don't fret over higher than average tendencies, reps say. Many Medicare providers c... Read more
Utilize These 5 Provider Resources for Opioid Crisis Questions
From prescribing to prevention, the feds have a site for it. If you look closely, you can... Read more
Physician Notes:
CMS Extends Low Volume Appeals Initiative
The window is open now, so don't delay. If you missed the Low Volume Appeals filing deadl... Read more
Reader Question:
Know These TCM Discharge Requirements for E/M Claims
Question: What types of discharge fall under the transitional care management codes? Cali... Read more
Reader Question:
Documentation Trumps Time for E/M Claims
Question: We saw a patient who hadn't been to our practice for over a decade, and she was ... Read more
E/M Coding:
Incorrect Codes, Poor Notes, and Setting Debacles Add to E/M Fails
CMS sees uptick in E/M claims problems. Evaluation and management (E/M) services are the ... Read more
Manage MSP Issues with Stronger Claims' Policies
Tip: Accurate patient information helps determine primary payer. Don't assume your patien... Read more
Determine Medicare or Private Payer with This Handy Chart
Tip: Check for dual-eligibility. There are a plethora of patient circumstances that impac... Read more
Know These Bipartisan Budget Act Changes Impacting Telehealth
The feds continue to promote telemedicine by lessening restrictions. With new codes outli... Read more
Industry Note:
OIG Offers New Gadgets for Compliance Inquiry
Accessing federal guidance, researching advice, and investigating the nitty gritty of heal... Read more
Industry Note:
CMS Market Saturation Tool Helps Determine Provider Density
If your town is overrun by specialists in your field, you may find the latest market updat... Read more
Industry Note:
Check Your 2018 MIPS Status with New Tool
Are you confused about whether or not you should be sending quality data to CMS this year?... Read more
Industry Note:
Food for Thought: Meal Planning Reduces Hospital Readmissions, Research Suggests
If you want to cut down on hospital readmissions, meal planning might be the ticket, sugge... Read more
Industry Note:
OIG Adds Statistical Sampling To Work Plan
If you thought claims reviews were getting tougher, you were right. Medicare auditors with... Read more
Reader Question:
Anthem Opts Not to Change Modifier 25 Policy
Question: Last year, we heard Anthem would start cutting its modifier 25 payment by 50 per... Read more
MedPac to Congress: MIPS Needs to Go
Most physician and hospital groups oppose the commission's drastic suggestions. Medicare ... Read more
Medicare Policy:
Slow MIPS Down, Bipartisan Budget Act Suggests
Hint: Don't expect the Cost category percentages to go up anytime soon. The first year of... Read more
Avoid Denials with This LT and Reciprocal Billing Primer
Tip: Manage modifiers correctly to ensure clean claims. Medicare providers work hard day ... Read more
Review These LT and Reciprocal Billing Key Points
Watch the NPI rules. Doctors go on vacations, have family emergencies, and get sick just ... Read more
Revenue Booster:
Make Light Work of Bundling Edits with This CCI Advice
Tip: Familiarize yourself with private payer policies to ensure steady pay. It's no secre... Read more
Put HIPAA Training at the Top of Your Spring To-Do List
Tip: Auxiliary staff need to feel safe to report violations. As HIPAA breaches rise in th... Read more
Industry Note:
Master ABNs with Noridian's New Tool
If filling out Medicare's Advance Beneficiary Notice of Noncoverage (ABN) form makes you b... Read more
Industry Note:
Azar Nominates HIV Expert to CDC Post
Last week, HHS Secretary Alex Azar named clinical researcher and HIV-expert Dr. Robert R. ... Read more
Industry Note:
MD Gets 3 Years in Jail and $3 Million in Restitution for PT Scam
As the feds continue to turn up the heat on Medicare fraudsters, more serious indictments ... Read more
Ace the Medicare Card and Number Transition From Day 1
Warning: CMS wants everyone on board by January 2020. In a few weeks, CMS will begin mail... Read more
Add These MBI Takeaways to Your Transition Checklist
Tip: For appeals, you can use either the HICN or MBI, CMS says. The Medicare card and num... Read more
Prepare for Federal Interoperability Change-Ups Now
Tip: It might be time to upgrade your CEHRT, CMS guidance suggests. Rollbacks and reversa... Read more
Get Ready for These Medicare Overhauls
Information blocking is a no-go, according to CMS. There's no denying that technology pus... Read more
Keep on Top of Signature Requirements to Sidestep Denials
Tip: Remember CMS does not permit attestations on physician's orders. If you've noticed a... Read more
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Know These CMP Changes the Budget Act Bumped Up
As Medicare fraud and abuse enforcement increases, so do the punishments. As the HHS Offi... Read more
Industry Note:
Review Hospice Provider Reports Before March 30
Quality data from the third quarter of 2016 to the second quarter of 2017 is now up and re... Read more
Industry Note:
Be Part of the Conversation on E/M Documentation Change
As CMS continues to scale back administrative burdens for Medicare providers, the agency r... Read more
Industry Note:
HHS Focuses On Value-Based Care for Medicare Reimbursement
During the Federation of American Hospitals' annual policy conference, new HHS Secretary A... Read more
Do You Qualify for the Low-Volume Appeals Option? Find Out
Settlements will only include a 62 percent partial recoupment. The Medicare claims appeal... Read more
CMS Revises Medical Student E/M Documentation Policy
Hint: New guidelines ease reporting restrictions. Many Medicare providers feel bogged dow... Read more
Update Your Documentation Protocols with These 7 Steps
Integrate medical student E/M documentation policy changes with this advice. The new upda... Read more
Clean Up Your Claims with Targeted Queries
Hint: Put your query in writing to avoid confusion. Subpar documentation ranks among the ... Read more
Address Risk Factors with These 3 Tips
Ignoring assessments and issues is not an option, OCR punishment suggests. Organizations ... Read more
Is the Stark Law Headed for the Chopping Block?
As the self-referral debate rages on, know these basics. Rumors continue to swirl that th... Read more
Industry Notes:
Gain Improvement Activity Credits By Participating in MIPS Study
If you or your practice struggled with MACRA's Quality Payment Program (QPP) quality repor... Read more
Industry Notes:
Cut Down On Paperwork with New Part A Tools
Starting this month, Medicare Part A providers "will have the option to submit Medicare co... Read more
Fraud And Abuse:
Feds Send Message with Huge Punishments — It's Payback Time
Hefty fines and long prison sentences epitomize 2018 settlements. The federal government ... Read more
Keep the Feds Off Your Back with 3 Tips to Fight Fraud
Tip: Strong notes back up claims and appeals. As Medicare fraud and abuse increase nation... Read more
Know the Ways to Submit 2017 MIPS Data By the Deadlines
There's still time to get your 4 percent increase. It's crunch time for Medicare Part B p... Read more
Industry Notes:
Window Opens to Share Your EHR-Measure Ideas with CMS
CMS is asking clinicians, researchers, and health organizations to submit their ideas for ... Read more
Industry Notes:
Medicare Adds Non-Skilled Home Care to MA Plans
A change to Medicare Advantage plan structure may benefit home care providers as well as p... Read more
Industry Notes:
Feds Latch Onto Telehealth for Opioid Crisis
One of telehealth's most important assets is the opportunity for physicians to advise and ... Read more
Conquer Claims Reviews with These 5 Tips
Be on top of your MAC's TPE guidance as the program evolves in 2018. Now that the MACs ar... Read more
Anthem's Controversial ED Policy Impacts 3 More States
Outrage about the policy suggests changes won't be made without a fight. Private insurer ... Read more
Practice Management:
Manage Your Online Image or Suffer the Consequences
Hint: Audit your cyber outreach to keep it legal and HIPAA-compliant. Before the onslaugh... Read more
HIPAA Imparts Updated Guidance in Midst of Opioid Crisis
HHS-OCR offers clarification for providers on information sharing. As physicians struggle... Read more
Industry Notes:
Part B Therapy Caps Get a Reprieve for Now
Therapy providers continue to lobby for concrete removal of therapy caps. Medicare is bac... Read more
New Medicare Texting Guidance Spells Out Dos and Don'ts
Physician orders should never be sent via text, CMS advises. Texting remains a thorn in h... Read more
Patient Engagement:
Is Patient-Provider Texting Right for Your Practice?
Texting may improve your practice intake, but make sure it's compliant first. What the he... Read more
Medicare Errors:
Back Up Your Claims with Accurate Notes — Or Risk Paybacks
CERT highlights providers' difficulties with compliant documentation. If you bill a subst... Read more
Pocket These Stats and See If Your Service Ranks
Home health and lab services remain high on the improper payment rate spectrum. Claims re... Read more
Review This Top 10 List of MAC Acronyms
Know these top acronyms commonly found in MAC coding and provider resources. CMS utilizes... Read more
Industry Notes:
CMS Offers "Patients Over Paperwork" Update
CMS promised in the fall to cut down administrative burden for providers in its initiative... Read more
Industry Notes:
Is Your EHR Edition MACRA-Ready and MIPS-Friendly?
Do you know if your EHR is certified? Is your vendor on the feds "banned" list? If you pla... Read more
Industry Notes:
Manage the MBI Transition with an Encore Presentation for Medicaid Providers
It's crunch time as most Medicare practices are preparing both patients and staff for the ... Read more
Don't Let Flu Vaccine Coding Leave You Out in the Cold
CDC issues warning that this year's flu season is already off the charts. Reports suggest... Read more
Alleviate Flu-Shot Claims' Woes with Roster Billing
Tip: Submit CMS-1500 for mass immunization claims. Preventive vaccinations have become al... Read more
How Will Your 99285 Claims Stack Up in an Audit?
Location may be a factor in higher levels of emergency department claims. Are you curious... Read more
Do Providers In Your State Bill 99285 More Than Others? Find Out
Hint: The results might surprise you. Although the average percentage of services billed ... Read more
Deadline Alert: Report MIPS 2017 Data to Avoid 4% Penalty
Remember your 2017 performance data impacts your 2019 Medicare pay. CMS initiated its new... Read more
HIPAA Compliance:
It Only Takes One Email to Cripple Your Health IT
Tip: Change your password often and don't share it with coworkers or friends. Email has b... Read more
Industry Notes:
Get Ready for the Jurisdiction J Transition
If you are a Medicare provider in Alabama, Georgia, or Tennessee, your practice claims, qu... Read more
Industry Notes:
New Anthem Imaging Policy Could Affect Your Paycheck
If you see patients who are covered by Anthem Blue Cross Blue Shield, it's a good time to ... Read more
Industry Notes:
Feds Extend PHE for Puerto Rico and U.S. Virgin Islands
Recovery from the devastation of Hurricane Maria has prompted the Department of Health and... Read more