In CMS
Apr 10th, 2019
Medicare Advantage (MA) enrollees have additional telehealth benefits thanks to a final rule released by the the Centers for Medicare & Medicaid Services (CMS). Telehealth Expanded Under New Rule Starting in 2020, Medicare Advantage enrollees will be able to access providers through electronic devices such as their computers, computer pads, and smart phones from their ...
Jun 5th, 2015
How sure are you that your inpatient rehabilitation facility is in compliance with the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)? The Office of Inspector General (OIG) isn’t so sure; and beginning in 2016, they will determine whether IRF claims are being paid in accordance with federal laws and regulations. IRF coverage requirements in ...
May 1st, 2012
Understand your use of CPT® codes prone to audit review. By Stacy Harper, JD, MHSA, CPC In the current regulatory environment, physicians are searching for ways to minimize audit exposure. Medicare administrative contractors (MACs) frequently review high-level evaluation and management (E/M) services. Review may be based on a random sample, or targeted based on provider ...
In Audit
Dec 2nd, 2011
In its Semiannual Report to Congress, the Office of Inspector General (OIG) announced 2011 exclusions of 2,662 individuals and entities from participation in federal health care programs, and expected recoveries of approximately $5.2 billion in audit and investigative receivables. The OIG also reported 723 criminal actions against individuals or entities that engaged in crimes against ...
May 1st, 2010
By Kerin Draak, MS, WHNP-BC, CPC, CEMC, COBGC Providers of long-term care services must comply with several different regulating criteria, and it is the coder’s responsibility to understand applicable rules when coding these unique services. In recent years, there have been extensive changes in the Nursing Facility Services section of the CPT® manual. Although this ...