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Medicare Compliance & Reimbursement

Physicians:
Will 'Welcome To Medicare' Exams Be A Welcome Addition?
Split codes mean physicians can outsource EKG testsIf you're worried about having to perfo... Read more
Pay-For-Performance:
MedPAC Continues Its Push On Pay-For-Performance
How long until providers are paid based on quality?  What Medicare will do is st... Read more
Reimbursement:
Pay Gains Could Be A Flash In The Pan, Report Warns
Zero in on problem areas through routine checks to protect your facility.Hanging your hope... Read more
Rehab:
Cardiac Rehab Supervision Falls Into Feds' Spotlight
Show off your outcomes data to keep docs hyped about your program.The word from CMS is tha... Read more
Physicians:
Sticker Shock May Scare Congress Out Of Saving Docs From Cuts
Docs should brace themselves for seven years of nightmares.Enjoy that 1.5-percent increase... Read more
Hospitals:
What CMS Will Be Asking Hospital Patients
New survey questions, pay-for-performance standards unveiled.Will new quality measures pro... Read more
Enforcement Watch:
Urologist Slammed For Heeding Drugmaker's Advice
You may not be immune from TAP marketing fallout.If you received free samples of Lupron pr... Read more
Hospice:
Hospices Look To New Billing Opportunities
Hospice docs can furnish consultation under new HCPCS code.Starting in January, hospices w... Read more
Bill Watch
The following bills were introduced in the House: HR 5393. A bill to amend title XVIII of ... Read more
Hospitals:
Don't Let Coverage Determinations Bury You
Bone up on the impact of regulatory changes.With the changes that recent Medicare legislat... Read more
Physicians:
Docs Will Wave Goodbye To $200 Million Next Year
Jump on the demonstration bandwagon to add to your payments. Good news: Physicians wi... Read more
Rehab:
OIG Work Plan Targets Admissions, Outliers In Inpatient Rehab Facilities
Zero in on problem areas through routine checks to protect your facility.The HHS Office of... Read more
Coverage:
Acupuncture Gains Codes, But Questions Persist
 Medicare has always refused to pay for acupuncture (97780-97781) but CPT 2005 delete... Read more
Physicians:
Get Ready For Some Big Changes In 2005
If doctors are in shortage areas, they could receive a nice boost.The conversion factor fo... Read more
Long-term Care:
Revamped Nursing Home Compare Coming Soon
Feds promise many more clarifications at upcoming November meeting.Heads up, long-term car... Read more
Physicians:
Docs Can Reap New Opportunities For CPO
If you have patients in home health care, billing Medicare for keeping tabs on them is eas... Read more
Enforcement Watch:
Liberty Medical Forks Over $35 Million Settlement
Beef up your compliance plan to withstand fraud charges.Four years of government scrutiny ... Read more
Physicians:
Immunize Yourself Against Losses On Vaccines
Physician fee schedule contains good news on other drug payments as well.Think oncologists... Read more
Labs:
Labs Falling Under Increased Scrutiny
Proposed bill could mean new whistleblower protections, trickier inspections.Tougher compl... Read more
Hospitals:
Final Outpatient Rule Increases Outlier Thresholds
Why it'll be harder than ever for hospitals to get extra reimbursement for costly cases.Un... Read more
Physicians:
Feds Taking Closer Look At Docs' Billing Companies
Here are the danger signs to look for in your contracts.If you're paying your billing comp... Read more
DME:
Suppliers Declare Victory On Face-To-Face Exams Dispute
$57 monthly dispensing fee for inhalation drugs finalized.The final physician fee schedule... Read more
Physicians:
Pay For Part B Drugs Cut, But Physicians Can Bill For More Services
3 simple rules for getting inpatient visits rightMedicare's final physician payment rule f... Read more
Hospitals:
Bank On These Changes For Outpatient Services
Ring in the New Year with a little bang for your bottom line.Some significant pay and poli... Read more
Physicians:
CMS Signs Off On 4-Percent Spending Hike For Docs
Find out what's wrapped up in the extra $2.2 billion package coming in January. The 1... Read more
Rehab:
CMS Clarifies CORF Coverage Rules
Here are the services that CMS will never cover in a CORF.If you're receiving denials for ... Read more
Enforcement Watch:
Documentation Crusade Targets Teaching Hospitals
How decade-old alleged errors reaped a $1.9 million settlement for one PA practice.Small l... Read more
Long-term Care:
New NPP Rule A Boon For SNFs, Too
Rule could increase revenue for SNFs and improve access to care.Come November, Medicare wi... Read more
Coverage:
Smarter Pay On The Way For ESRD Services
Good news for physicians who treat end-stage renal disease. New adjustments to the physici... Read more
Long-term Care:
Are SNFs Ready For Surprise Spot-Checks?
 "Operation Spot Check" in Florida leads to big citations.Your compliance efforts cou... Read more
Physicians:
OIG Scare Tactics Aim To Keep E/M Levels Down
Physicians, home health agencies caught in Catch-22.Is your billing company helping you up... Read more
Coverage:
Medicare Announces New Cancer Drug Admin Codes
But are they enough to offset oncologists' losses in other areas?Effective Jan. 1, 2005, t... Read more
Physicians:
Carrier Guidance May Lead To Physician Overbilling
What the carriers leave out could be as important as what they say.If you're relying on yo... Read more
Physicians:
Don't Wait 'til The Midnight Hour To Bill For Admission
3 simple rules for getting inpatient visits right.Even the carriers are confused about the... Read more
Long-Term Care:
SNFs Should Take Steps Toward Quality, Or Else
Ignoring these 5 regulatory hot spots could be disastrous.The spotlight on quality of care... Read more
Medicare Advantage:
New Carotid Stent Technique Wins Coverage
Physician practices that perform percutaneous transluminal angioplasty (PTA) with carotid ... Read more
Fraud & Abuse:
9 Fraud Hotspots For 2005
Be warned: There are more OIG probes on the way.It's going to be a busy year for fraud enf... Read more
Enforcement Watch:
Wrong Place, Wrong Code? Big Fines
Location is everything when it comes to Medicare claims.Payors are under increasing pressu... Read more
Hospice:
Hospice Pay May Shrink
The good news is, for the first time since 1983, the payment methodology and rates for hos... Read more
Physicians:
Stark Law Loophole Could Jumpstart E-Prescribing
If electronic prescribing seems far too difficult a path for most practices to travel, new... Read more
PHYSICIANS:
Let Docs Choose Level For 'Welcome To Medicare' Exam Codes, AMA Urges
Physicians hoping to change payment policy before implementation in '05.With the Centers f... Read more
PHYSICIANS:
Christmas May Come In November For Docs Who Dispense Drugs
But it's up to CMS to decide whether docs get coal or candy.Physicians could see a major i... Read more
HOSPITALS:
Once An Inpatient, Not Always An Inpatient
Know your patient's status with new condition code.Here's the deal: The physician admits a... Read more
HOME HEALTH:
$20 Million Cut From HHA Spending In 2005
Tinkering with inflation factor strips nearly $4.50 from episode base payment rate.Get rea... Read more
COVERAGE:
How To Get Your Therapy Billing Questions Answered
Therapy gets new billing Web site from CMS.If you want to know exactly how to bill Medicar... Read more
ORTHOPEDICS:
New Knee Arthroscopy Codes Spark Debate
What place does sports medicine have in Medicare?Many orthopedists welcome CPT's new knee ... Read more
LONG-TERM CARE:
Don't Sign On The (Digital) Dotted Line Yet
Signing clinical records electronically too soon could cost you.Less than a month after CM... Read more
ENFORCEMENT WATCH:
Justice Department Taking Closer Look At Hospice
Odyssey CEO resigns as earnings falter.Is a Department of Justice investigation of Odyssey... Read more
MEDICARE ADVANTAGE:
CMS Stresses Tight Timeline On MA Implementation
Health plans will need to act fast to take advantage of Medicare AdvantageMany questions s... Read more
ONCOLOGY:
Get Ready For Increased Chemotherapy Coverage
CMS may expand definition of chemotherapy in 2005.The CPT Editorial Panel made some far-re... Read more
REHAB:
What PTs Do Wrong When Billing For Home Visits
PTs need to show they delivered skilled therapy.Therapists know that Medicare will reimbur... Read more
HOSPITALS:
New Fraud Hotspots For Hospitals Revealed
Hospitals should hone in on these key compliance areas.The HHS Office of Inspector General... Read more
LONG-TERM CARE:
The Most Overlooked Billing Opportunity For SNFs
Many nursing homes accidentally volunteer for a cut in their Medicare reimbursement.Nursin... Read more
LABS:
What The New Screening Regs Mean For Labs
Diabetes, heart disease screening changes will help labs in 2005.Next year labs won't alwa... Read more
HOSPITALS:
What's Shaking For New Distinct-Part Units
Get the latest word on new reform bill provision for CAHs.Critical access hospitals that w... Read more
COVERAGE:
Get Set For New HCPCS Updating Process
What you need to know about Medicare's effort to 'speed the use of technology.'Dramatic in... Read more
ENFORCEMENT WATCH:
Take Pains To Avoid These Delivery Billing Mistakes
Why one physician had to hand over half a million to Medicaid.Physician practices that bil... Read more
PHYSICIANS:
Will CMS Pay Interest On Claims Delayed By PECOS?
Stay tuned for more enrollment bottlenecks in 2005.With providers waiting months before th... Read more
BILL WATCH
The following bills were introduced in the House: HR 5278. A bill to ensure and foster con... Read more
Ambulatory:
New Changes On Tap For OPPS In '05
Observation guidelines and drugs receive federal scrutiny.Be prepared: The Medicare Modern... Read more
Long-Term Care:
'Under Arrangement' Clarification Could Aid SNFs
September ODF promises relief from confusion for nursing homes.Don't look now, but the Cen... Read more
Hospitals:
ER Admissions Staff Won't Have To Double As INS
CMS finally agrees: Immigration and emergency care don't mixThe Centers for Medicare &... Read more
Rehab:
IRFs Can Keep In The Clear With These Strategies
Putting skill in skilled service notes is the best audit protection.If inpatient rehab fac... Read more
Long-Term Care:
Fix Certification Errors With These Three Easy Steps
Nursing homes don't need to repeat the same mistakes.If long-term care providers aren't ce... Read more
Home Care:
HHAs Get Ready For Revamped Appeals Process
New 'QIC' step could bring quicker objective review.Medicare is again tinkering with its a... Read more
Enforcement Watch:
Operation Wheeler Dealer Rolls Over Houston Doc
Providers should make sure their paperwork can stand up to increased scrutiny.The Texas fr... Read more
Hospitals:
How To Bulletproof A Hospital's Staffing Compliance
2 crucial compliance steps you can't do without.Even if a hospital has buckled down on fed... Read more
Program Transmittal Roundup
The Centers for Medicare & Medicaid Services said in an Aug. 27 transmittal (CR 3418) ... Read more
Bill Watch
Bills introduced in the House: HR 5157. A bill to amend title II of the Social Security Ac... Read more
Physicians:
Save The 'Shared Visits' Rule For The Hospital Ward
Don't try to combine NPP/physician visits in the office setting.Some things are better not... Read more
Physicians:
Incident-To Billing: Supervising Doc Doesn't Have To Be Plan Of Care's Author
The Centers for Medicare & Medicaid Services clarifies in Change Request 3460, dated S... Read more
Surgery:
Neurosurgeons Gain Key Senate Victory
But language won't have any reimbursement impact, say oncologists. Neurosurgeons who feel ... Read more
Senators Push For Oral Cancer Coverage Sooner Than 2006
The Senate report also urged CMS to address the "unintended consequences" of current reimb... Read more
Medicare Advantage:
Rules On Formularies, PPOs Raise Concerns
Many questions remain before Medicare reform can be completed. As the Centers for Medicare... Read more
Cardiac Care:
CHF Clinics Soon May Lose A Treatment Method
Carriers remove coverage for Natrecor in office setting. Physician offices running congest... Read more
Hospitals:
HHAs Lose Out On PRRB Ruling
Provider to file appeal in federal court over physical therapist compensationHome health a... Read more
Coverage:
The Scoop On How CMS Makes Coverage Decisions
New guidance documents take some guesswork out of the NCD process.Are you frustrated ... Read more
Hospitals:
Is CMS' OPPS Rate Undercutting Hospitals' Pay?
GAO: 'Payment for drugs, devices, services does not uniformly reflect hospitals' costs.'Ma... Read more
Carriers:
Three New Reasons You Can Trust Your Carrier
Get ready for an about face from your Medicare contractor's customer service center. You c... Read more
Drug Payments:
2005 Drug Rates Will Be A Surprise - Even To CMS
Nobody will know in advance the numbers on which Medicare will base drug payments in 2005,... Read more
Physicians:
Don't Expect Payors To Be Up-To-Date On New Codes
Here's how to ensure smooth sailing while payors adjust.Just because Medicare expects prov... Read more
Home Health:
MedPAC Wants HHA Payments Tied To Quality
Advisory commission forges ahead despite industry's concerns.More than home health agencie... Read more
Health Plans:
Why More Health Plans Are Moving Into Medicare
Higher premiums could give seniors more incentive to enter private plans.Is now the time f... Read more
Physicians:
'Welcome To Medicare' Exam Could Make Doctors Into Doormats
Level 3 office visit reimbursement not enough for difficult service, physicians complain.F... Read more
Drug Benefit:
CMS Posts Comparison Prices For Popular Drug Classes
Online tool enables beneficiaries to look up, compare prices.With the Sept. 15 launch of a... Read more
Long-Term Care:
SNFs Hearing Mixed Messages On E-Signatures
Confused? Get the inside line from state surveyors.The use of electronic signatures for cl... Read more
Hospitals:
New Standardized Quality Measures On The Way For Hospitals
Technical manual should reduce reporting burdens, McClellan says.The Centers for Medicare ... Read more
Enforcement Watch:
Cutting Corners On Care Costs More Than You Think
Million-dollar settlement brands 13 nursing homes with charges of mistreatment.Even if a b... Read more
Coverage:
PET Coverage May Herald New Era In Clinical Trials
With evidence limited on effectiveness, coverage too will be limited.The Centers for Medic... Read more
Long-Term Care:
DOJ Launches Wide Medical-Supply Probe
The Department of Justice is looking into how medical-supply companies market to nursing h... Read more
Bill Watch
Bills introduced in the House: HR 5116. A bill to amend title II of the Social Security A... Read more
Physicians:
Providers Could See End To PECOS Mess Soon
But provider reps frustrated by slow progress.The pace of the Provider Enrollment Chain an... Read more
Rehab:
75-Percent Rule Is One Step Closer To Being Shelved
Congress may put quick end to controversial regulation.Rehab providers still have reason t... Read more
Coverage:
Electrocardiography Wins Wider Coverage
Ambulatory monitors, 24-hour attendance gain Medicare payments.Doctors could be receiving ... Read more
Drug Benefit:
Proposed Formulary Poses Problems For Plans, PBMs
Number of drug categories will make it tough to contain costs, groups say.With the Part D ... Read more
Long-Term Care:
SNFs Struggling With New Supplier Contract Regs
Nursing homes can protect their interests without jumping through legal hoops.The newly pr... Read more
Home Care:
HHAs Win Relief From Deluge Of Medicaid Forms
No need to reassess all Medicaid patients in 5-day window, CMS says.Home health agencies h... Read more
Legislative Update:
What To Expect From Congress In 2005
There should be little legislation before New Year's '05, but then everything changes.Cong... Read more
Enforcement Watch:
Why 2005 Could See An Even Stronger OIG
Find out how the watchdog will be keeping busy with beefed-up funding.The Medicare Moderni... Read more
Hospitals:
This October, Hospitals' IPPS Ship Comes In
More DRGs mean more money for hospitals.Several diagnosis-related groups are on deck for u... Read more
Coverage:
CMS Takes Closer Look At Stent Replacement
Medicare coverage for a new stroke-prevention procedure could be coming down the pike.In a... Read more
Physicians:
NPPs Can Bill For Care Plan Oversight
Starting next year, non-physician practitioner staff can keep track of home health care pl... Read more
Bill Watch
The following bills were introduced in the House: HR 5048. A bill to amend title XVIII of ... Read more
Hospitals:
Stay On Top Of Ever-Changing Coverage Determinations
How to bone up on regulatory changes' impact on your business.With the changes that recent... Read more
Rehab:
IRFs Balance Good PPS News With Bad Reg Changes
Can a market-basket boost offset the 75-percent rule bust?Inpatient rehab hospitals are lo... Read more
Oncology:
Oncologists Lack Info To Prepare For The Worst
Docs won't know details of looming treatment cuts until late this year.The suspense is kil... Read more
Physicians:
Temporary Codes Already On The Books For 2005
AMA has released Category III codes, and more carotid catheterization codes are coming.The... Read more
Long-Term Care:
CMS Letters To SNFs Not As Harsh As They Sound
SNFs shouldn't let the initial state survey notices send them on a wild goose chase.Alarme... Read more
Home Health:
Why DMEPOS Rule Could Make Docs' Lives Harder
Physicians are required to see patients to prescribe supplies, but Medicare won't pay.A ne... Read more
Home Health:
Suppliers Gain Allies In Fight Against Exam Rule
Docs are on suppliers' side when it comes to fighting new red tape.There is hope that the ... Read more
Enforcement Watch:
Pharmacy Takes Cover In Recycled Drug Loophole
Court says 'disturbing' lack of legal authority proved fatal to lawsuit.A federal appeals ... Read more
Medicaid:
CMS Clamping Down On Medicaid Payment Errors
Heads up: The government may be dabbling with your medical records.Head up, providers. If ... Read more
Beneficiaries:
Guess Who'll Pick Up The Tab For The Reform Bill?
Expect to see some unhappy Medicare beneficiaries.The good news for providers is that 2005... Read more
Rehab:
Therapists Cheer Revised 'Incident To' Requirements
New rule would redefine who provides therapy in doctors' offices.Therapists tired of Medic... Read more
Loosened Supervision Requirements A Boon For Therapists
Here's what it means for the rehab industryWhile tightening incident-to billing requiremen... Read more
Physicians:
New 'Incident-To' Rules Tough For Docs To Take
'Incident-to' means employees, services - but not other doctors.The party may be over for ... Read more
Home Care:
Pressure Ulcer Change Could Cost HHAs
HHAs should prepare for scrutiny of this high-dollar OASIS coding revision.There will be n... Read more
Hospitals:
What's Not Covered On Organ Transplants
Hospitals may have to refund employees' salaries if activities aren't documentedIf a hospi... Read more
Oncology:
2 Hopes For Saving Drug Payments In 2005
New codes or new legislation cold rescue practices. It's going to take a minor miracle to ... Read more
Enforcement Watch:
Yes, You Can Do Time For HIPAA Violations
Watch for more prison sentences for privacy rule abuses.Wake up, providers: Since its ince... Read more
Hospice:
Will 2005 Pay Update Be A Boon Or A Bust?
What hospices can expect come October 1.The annual pay update for hospice services is in.A... Read more
Physicians:
Docs Could Pay A Price For Claiming Free Samples
Charging Medicare for drug promos is a big no-no.There are strings attached to those free ... Read more
Physicians:
Cheaper Equipment + Reduced Pay = Better Care?
The official word on respiratory therapy. Heads up, physicians. Patients who need and use ... Read more
Outpatient PPS:
6.6-Percent Pay Boost On Its Way For Outpatient Pay
Administration fees soar from 2003, but plummet from 2004.Hospitals are about to receive s... Read more
Long-term Care:
SNFs Should Heed Admission Rules
Here are the hoops nursing homes will have to jump through if CMS heeds new advice.The reg... Read more
HIPAA:
Top 5 Questions On The HIPAA Security Rule
Good news: CMS offers more guidance on HIPAA.Security rule questions got you scratching yo... Read more
Physicians:
Income Guarantees For Recruits Guarantee Pain
Wave goodbye to non-compete clauses for new physicians.Physician practices that partner wi... Read more
Physicians:
Stark II Regs Spell Changes For Doc Recruitment
Prepare to bring contracts into compliance.In the past, physicians and hospitals have sign... Read more
Policy:
Got A Question? Don't Ask Your Carrier
They only get the answers right 5 percent of the time, GAO says.If you have questions on M... Read more
Rural Providers:
Rural Docs Could See A 15-Percent Hike
Why some will benefit from the physician shortage.Good news for rural physicians. They cou... Read more
Enforcement Watch:
Big Apple Says AWP Is More Than It Can Chew
Allegations could signal another round of pharmaceutical settlements.States looking for a ... Read more
Rehab:
IRFs Need To Get Up To Speed On PPS Regs
Here are the billing mistakes the OIG is looking for. If inpatient rehab facilities w... Read more
Home Care:
Hospitals Must Inform Discharged Patients Of All HHA Options
CMS unveils new steps to "improve" hospital training. Ensuring hospitals give patient... Read more
Physicians:
Medicare Drugs Slashed Up To 90 Percent Next Year
Administration fees soar from 2003, but plummet from 2004.Physician practices that provide... Read more
Hospitals:
More DRGs Are Tapped For Pay Increase
How CMS plans to tinker with the inpatient prospective payment system. Several diagno... Read more
Long-term Care:
Hype Meets How-To: What SNFs Need To Know About Transitional Assistance
How to reduce paperwork and liability - and maximize benefits for residents.Are skilled nu... Read more
Labs:
How To Perform Equivalent Quality Controls
Labs should determine if they qualify for the CMS-sanction alternative.Labs that are ready... Read more
Hospitals:
Hospitals Must Keep Track Of Transfers
Losing track of inpatients could cost hospitals bundles of reimbursement.Do hospitals know... Read more
Physicians:
What MDs Need To Know About Welcome To Medicare' Exams
Benes eligible for 6 months after start of Medicare coverage.The new physician fee schedul... Read more
Coverage:
Keep Up With Cardiac Implant Guidelines
Here's what Medicare says about reimbursement for pacemaker implantation.If providers were... Read more
Enforcement Watch:
Don't Let Patient Requests Jeopardize Compliance
Why three Louisiana SNF caregivers could go to jail.Warn your employees about the dangers ... Read more
Compliance:
CMS To Stop Overcharging For Overpayments
Find out which hidden costs you'll no longer need to worry about.Starting this fall, there... Read more
Hospitals:
Brush Up On Changes To Graduate Medical Pay
CMS unveils new steps to "improve" training.While you're making way for the barrage of pol... Read more
PROGRAM MEMO ROUNDUP
The Centers for Medicare & Medicaid Services said in a July 30 program transmittal (CR... Read more
Hospitals:
CMS Lowers Outlier Threshold In Inpatient Rule
CMS Lowers Outlier Threshold In Inpatient RuleUnder the final Medicare inpatient payment r... Read more
Surgery:
Stereotactic Radiosurgery Coverage Still Tricky
Doctors are trapped by Medicare reimbursement.Physicians providing stereotactic radiosurge... Read more
Medicare Doesn't Always Cover Arthroscopy
For patients with knee osteoarthritis, arthroscopy offers a way to look inside the joint. ... Read more
Long-term Care:
SNFs Face Tough Financial Realities When Complying With Medicare Guidelines
Nursing homes face possible fines of $50,000 or more. The feds and many states are pu... Read more
Five Steps For Winning The Regulatory Battle
 What SNFs need to know now.To protect themselves from compliance problems, SNFs shou... Read more
Physicians:
What's In Store For Physicians' Bottom Line
Physicians can catch their breath; CMS presses on toward preventive care.What's on tap for... Read more
Enforcement Watch:
Firms Should Be Vigilant On Reporting Drug Prices
Schering-Plough pays $345 million for allegedly wheeling and dealing with Medicaid.Blockbu... Read more
Home Health:
HHAs Could Face New Quality Measures
Number of process-based measures could replace patient outcomes.An organization few people... Read more
BILL WATCH
No bills this week, as Congress enjoys its summer vacation and politicians hit the campaig... Read more
Physicians:
Docs Should Prepare Now For 'Welcome To Medicare' Exams In 2005
6 tips to pave the way for initial Medicare physical exam.Starting next year, Medicare wil... Read more
Medicare Advantage:
CMS Unveils Drug Plan, Potential Medicare Regions
The final region determinations will be key factors in health plans' Medicare success.Heal... Read more
Drug Payments:
Doc Pay Rule Cuts Drugs Up To 89 Percent
Oncologists aren't fans of new proposed rule.The proposed physician payment rule for 2005 ... Read more
Long-term Care:
How CMS Can Fund Your Employee Screening
$25 million should put a little muscle back into weak background check systems.Extra fundi... Read more
Oncology:
Carriers Set Limits On New Breast Cancer Technique
APBI policies follow physician society's recommendation.A new technology is revolutionizin... Read more
Reimbursement:
SNFs, Inpatient Rehab Can Bank On Better Pay
What's brewing in the financial forecast for 2005.Good news for hospitals and skilled nurs... Read more
Enforcement Watch:
How To Shrug Off An Anti-Kickback Investigation
Eight TAP execs off the hook for drug marketing tactics.The collision between the feds and... Read more
Coverage:
NCD A Washout For Arthroscopic Lavage
Why your arthritic patients may be turning away.Providers hoping the Centers for Medicare ... Read more
Bill Watch
Bills introduced in the House: HR 4898. A bill to amend title XVIII of the Social Security... Read more
DIABETES:
Streamline Your Diabetes Reporting With New Codes
"Insulin-dependent" distinctions are no more Providers may find it easier to assign diabet... Read more
RADIOLOGY:
Interventional Radiologists Fear Stark Crackdown
SIR caught in the middle between treating docs, radiologists. The law of unintended conse... Read more
COVERAGE:
Imaging Crackdown May Require Legislation
CMS can intervene, but there's a limit to its powers. It may require legislation to preve... Read more
HOSPITALS - Wanted:
Your Info On Undocumented Aliens
Reward: your share of $1 billion MMA fund. The Centers for Medicare & Medicaid Service... Read more
HOSPITALS:
Grassley, Stark Want More Oversight Over JCAHO
Who's overseeing the overseers, legislators want to know. On July 20, Sen. Chuck Grassley... Read more
COVERAGE:
Will Medicare Pay For Your Obesity Treatments?
CMS Administrator says "medical science will decide." Though the ground hasn't broken yet... Read more
COMPLIANCE:
Are You Overlooking Something The OIG Won't?
Here are the mistakes federal inspectors are ready to pounce on. Coding, double-billing, c... Read more
ENFORCEMENT WATCH:
ENFORCEMENT WATCH:
Medicare fraud charges leveled at suppliers in Texas, Pennsylvania. Operation Wheeler Deal... Read more
TECHNOLOGY:
CMS Makes A Plug For Getting Wired
What new health information technologies are headed your way? A new initiative from the C... Read more
BILL WATCH
Bills introduced in the House: HR 4871. A bill to amend title XVIII of the Social Securit... Read more
PHYSICIANS:
Group Practices Performing Diagnostic Tests, Beware
Tests won't be incident-to any longer, CMSofficials say. For decades, physician practices... Read more
PHYSICIANS:
Separate Tests Vs. Incident-To: A Stark Difference
At first glance, the new policy that the Centers for Medicare & Medicaid Services snea... Read more
COVERAGE:
EPO Policy Gets A Check-up
Plans get creative to secure best deals while complying with antitrust laws. A draft revis... Read more
HOSPITALS:
See Which Hospitals Stand To Win With IPPS 2005
Proposed rule is a mixed bag for facilities. For only the third time in 21 years, hospital... Read more
LONG-TERM CARE:
Is Nursing Home Compare Telling The Whole Story?
Grassley says certification process "isn't working." An inspection report released July 1... Read more
HIPAA:
Mark Your Compliance Calendar For New HIPAA Regs
Here's what's coming down the administrative simplification highway. Attention rule-watch... Read more
CODING CORNER:
Postacute Care Throwing You For A Loop?
Three hints for straightening out your patient-status coding. Many hospitals have had dif... Read more
DME:
Expect Wheelchair Downcodes Once Scooter Regulations Are Finalized
Expect Wheelchair Downcodes Once Scooter Regulations Are Finalized A rule making it easie... Read more
BILL WATCH
Bills introduced in the House: HR 4822. A bill to amend title XVIII of the Social security... Read more
LONG-TERM CARE:
Consolidated Billing Takes Center Stage At Forum
SNFs can keep their claims humming by noting these CB shifts. Clarifying is the name of t... Read more
RADIOLOGY:
Bar 'Self Referrals' of Imaging Tests, ACR Urges CMS
CMS trying to cut back on steep increase of MRIs and CAT scans. Can the Centers for Medic... Read more
HOSPITALS:
Big ICD-9 Changes On Their Way
New codes take effect Oct.1., ready or not. If providers were banking on the usual 90-day ... Read more
HOME CARE:
Lack Of Documentation Can Cost HHAs Thousands
One agency lost $37,000 thanks to spotty record-keeping. How much is enough? That's the p... Read more
PHYSICIANS:
Doctors Could Be Throwing $1,400 Away
Downcoding just two E/M visits a week can cost an arm and a leg. It may not seem like a b... Read more
PHYSICIANS:
Physician-Payment Overhaul Could Be In The Works
Current system has too many problems, experts say. Come fall, expect Congress and the Med... Read more
COVERAGE:
Injectible Cancer Drugs Put On Pass-Through List
But don't get used to the new money just yet. The Centers for Medicare & Medicaid Ser... Read more
COVERAGE:
CMS Boosts Ambulance Payments
Some ambulance services will get a "super-rural" bonus under an interim final rule issued ... Read more
BILL WATCH
Bills introduced in the House: HR 4491. A bill to amend Part B of title XVIII of the Socia... Read more
PHYSICIANS:
Docs Won't Be Able To Capitalize On PET Scans
But more expansion may be on its way. Medicare issued a draft of the long-awaited decision... Read more
HOME CARE:
Confirm M0175 Takebacks With New CWF Option
HHAs should get to know 'APPDATE' field to ensure proper recoupments. How will home healt... Read more
PHYSICIANS:
CMS Promises PECOS Problems Resolved By Fall
But a new slew of enrollment problems is on the horizon. Promises, promises. Providers ha... Read more
MEDICARE ADVANTAGE:
More Health Plans Getting Involved In Medicare
New reform makes Medicare a much more attractive market for private plans. With new payme... Read more
PRESCRIPTION DRUGS:
Stand-Alone Rx Plans May Be Doomed, Experts Say
Success of Medicare Part Dis anything but certain. Private prescription drug plans simply... Read more
STARK:
Does Stark II Single Out Group Practices?
MGMA says Stark should be friendlier to physician recruitment. With Phase II of the Cente... Read more
COMPLIANCE - CERT Medical Record Requests:
What All Providers Need To Know
OIG checks in to see who is -- and who is not -- handing over the files. Still haven't se... Read more
PAY-FOR-PERFORMANCE:
Medicare May Soon Pay Extra For Top Quality
What regulators think of pay-for-performance. When it comes to changing Medicare's paymen... Read more
PROGRAM TRANSMITTAL ROUNDUP
Get ready for the Centers forMedicare & Medicaid Services changes to the Hospital Outp... Read more
BILL WATCH
Bills introduced in the House: HR 4626. A bill to amend title XVIII of the Social Security... Read more
REHAB:
PTs Working With SNFs Make Key Coding Mistakes
How therapists can correct these costly blunders. Therapists should think twice before th... Read more
HOME HEALTH:
HHAs Getting Burned On Homebound Status
Two crucial homebound documentation areas keep tripping up HHAs. Homebound status might b... Read more
PHYSICIANS:
Billing For Digestive Surgeries Is Causing Heartburn
Here's what physicians can and can't bill for. Physicians who are performing a lot of dig... Read more
LONG-TERM CARE HOSPITALS:
Expect Payments To LTCHsTo Shrink In Near Future
MedPAC almost, but not quite, recommends moratorium. With Medicare spending on long-term ... Read more
PHYSICIANS:
3 Questions Can Heal Decubitus Ulcer Coding Sores
Poor documentation could cost providers up to $350 per patient.Coders for physicians shoul... Read more
HOSPITALS - Medicare Fractions 101:
Let CMS Do Your DSH Math
What hospitals do -- and don't -- have to worry about with the complex DSH pay formula. C... Read more
HOSPITALS:
CMS Finally Agrees To Cover PET Scans
Experts remain lukewarm on the new coverage. After numerous requests to reconsider its pr... Read more
LONG-TERM CARE:
SNFs, Suppliers Must Shake Hands On Consolidated Billing
Communication breakdowns lead to big billing problems for both. Suppliers' claims are comi... Read more
COMPLIANCE:
Faulty Advice From Consultants Could Cost You Big
7 ways to protect your organization from bad advice. Many health care providers enlist th... Read more
PHYSICIANS:
Beware Of Hurdles In Brave New E-Scrip World
New technology also means new problems to look out for. The Medicare Modernization Act ca... Read more
HOME HEALTH:
PPS Reshuffling Will Affect HHA Rates In 2005
Outlier, wage index changes most significant in new PPS rule. Outlier patients may be les... Read more
HOSPITALS:
No HCPCS Code? Get Paid Anyway
What hospitals need to know when submitting claims for new drugs. Good news for hospitals... Read more
PHARMACEUTICALS:
OIG Makes The Case For Drug Pricing Change
Federal investigators taking a closer look at pharma industry. The HHS Office of Inspecto... Read more
HOSPITALS:
Get Coders Up To Speed On Transfers, Discharges
Data entry errors could put providers on a collision course with the OIG. Hospitals need ... Read more
MEDICARE DRUG CARD:
Can More Choice Be The Wrong Choice?
Democrats wonder if seniors are confused by multiple card options. At a June 8 Senate Fin... Read more
AUDIOLOGY:
New Rule Takes Guess Work Out Of Audiologist Requirements
For the first time in 20 years, audiologists can expect an update to Medicaid requirements... Read more
HEALTH PLANS:
Health Plans Win 6.6% Boost For 2005
The good news keeps getting better for Medicare Advantage plans. The Centers for Medicare ... Read more
BILLWATCH
The following bill was introduced in the Senate: S 2512. A bill to amend title XVIII of th... Read more
PHYSICIANS:
No E/M Coding Changes Until 2006
Clinical examples are too subjective to please CMS auditors. Physicians shouldn't throw a... Read more
LONG-TERM CARE:
DAVE Comes Knocking On SNFs'Doors
Nursing homes will need to be proactive to dodge losses -- and even realize big gains. A ... Read more
HEALTH PLANS:
New HSA Guidance Allows For Design Flexibility
Government's enthusiasm for HSAs is good news for health plans. The Bush administration i... Read more
HOSPITALS:
Hospitals Must Account For Their GME Revenue
 MI hospitals face increased scrutiny after OIG's repayment request. Hospitals may ne... Read more
HEALTH PLANS:
CMS Wants Plans'Input On MMA Regions
July 21 meetings will consider regional definitions for MA plans and PDPs. Heads up, mana... Read more
HOME HEALTH:
HHAs May Ring In '05 With 2.5-Percent Pay Hike
New PPS calendar pushes back updates, may save Medicare $90 million. Good news for home h... Read more
MEDICARE DRUG CARDS:
Analysts Dissect The Drug Card
Will they save seniors money?Are they a waste of money? The reviews are mixed. The Medica... Read more
MEDICARE DRUG CARD:
Has 'Misinformation' Hurt Drug Card Program?
CMS is reporting lower-than-expected membership figures. For months Congressional Democra... Read more
LONG-TERM CARE:
New Admits Are Tricky For Some SNFs
Admissions on or after the effective date of a denial of payment remedy pose big problems ... Read more
BILL WATCH
The following bills were introduced in the House: HR 4491. Abill to amend Part B of title ... Read more
REHAB:
Rehab Facilities Make Costly Comorbidity Errors
IRFs could be earning much more if they mastered comorbidity coding. Inpatient rehab faci... Read more
PHYSICIANS:
Docs Can Bill More Radiation Treatments
Understanding the timing of same-day reporting is key for physicians. Contrary to common ... Read more
HOME CARE:
HHAs May Win Relief From MSA Changes
Surveys,M0175 also addressed in forum.Home health agencies will face sometimes-crippling ... Read more
HEALTH PLANS:
Another Report Says Plans Get More Than FFS
Medicare reform is steering the dollars towards managed care plans. According to a May 20... Read more
HOSPITALS:
When Hospitals Can Bill For Outpatient Therapy
Three scenarios clear the mark,CMS says. Hospitals have long been confused as to when the... Read more
HOSPITALS:
How To Claim Pool Refunds On Cost Reports
Accounting for provider tax refunds is trickier than hospitals think. The HHS Office of I... Read more
BILLWATCH
Bills introduced in the House: HR 4374. Abill to require Medicare providers to disclose pu... Read more
PROGRAM MEMO ROUNDUP
Heads up, durable medical equipment suppliers. The Centers for Medicare & Medicaid Ser... Read more
Appeals:
CMS Requires Independent Carrier Hearing Officers
Changes help level the playing field.A formerly insignificant legal argument may soon beco... Read more
ABN:
Achieve ABN Success In 4 Simple Steps
When Medicare is shy, break the ice with these forms.Misinterpreting the extensive rules f... Read more
Dialysis:
OIG Says Dialysis Drug Payments Exceed Costs
Government continues to take closer look at drug costs.Last year, Medicare's four largest ... Read more
Medical Records:
Beware Of Coding By Numbers When Using EMRs
EMRs can pose problems with documenting services, proving necessity.Electronic medical rec... Read more
Prescription Drugs:
CMS Says Rx Cards Save Over Retail
But many critics disagree as seniors begin to enroll.Medicare beneficiaries using the new ... Read more
Home Care:
Home Care Braces For Crackdown On Doc COP
100% of physician care plan oversight claims denied in preliminary audit.The HHS Office of... Read more
Hospitals:
Is Your Compliance Program Effective?
There's a new way to find out.Compliance officers have long struggled over how to demonstr... Read more
Medicaid:
Senate Votes To Extend Medicaid For Disabled Kids
Change would end income loophole for many families.States could allow middle-income famili... Read more
Health Plans:
Not All Group Plans Are Exempt From HIPAA
Only some provisions are mitigated for fully insured plans.Group health plans may not need... Read more
Bill Watch
Bills introduced in the House: HR 4231. A bill to amend part D of title XVIII of the Socia... Read more
Rehab:
Get Ready For The New, Phased-in 75% Rule
How the new rule will change the rehab industry.Inpatient rehab facilities have been waiti... Read more
Rehab:
IRFs Must Act Now On 75% Rule Compliance
Rehab providers don't have long to meet the threshold.Fiscal intermediaries will be tracki... Read more
DME:
Trio Of Pricing Changes Threaten Wheelchair Pay
DME suppliers should prepare for face-to-face requirement.Suppliers have been suffering un... Read more
Physicians:
Physicians Face Seven Lean Years Starting In 2006
Can Congress agree on a way to avert $90 billion in cuts?Congress built this house, now do... Read more
Oncologists:
Oncologists To CMS: Give Us The Bad News First
Legislators write to CMS asking for payment rate information.Physicians who provide chemot... Read more
Long-Term Care:
More Reimbursement On The Way For AIDS Patients
Long-term care facilities receive needed boost.Nursing homes that treat AIDS patients will... Read more
Long-Term Care:
Final Rule Contains Big Increase For LTCHs
Long-term care hospitals could be big winners.Medicare payments to long-term care hospital... Read more
DME:
Feds Demonize Wheelchair Advertising In Senate
OIG paints DME industry with broad fraud brush.A festival of finger-pointing between feder... Read more
Mental Health:
'Incident To' Won't Fly Without Supervision
Though psychologist Dr. Richard Cook said he had no intention of defrauding the government... Read more
Bill Watch
Bill introduced in the House: HR 4304. A bill to amend the Medicare Prescription Drug, Imp... Read more
Health Plans:
Can PPOs Really Save Medicare?
PPOs may not be up to the challenge, new study says.Based on the experience of preferred p... Read more
DME:
New Codes, More Changes For Power Wheelchairs
Planned bright lines should help suppliers figure out coverage.The Centers for Medicare &a... Read more
Home Care:
HHAs' OASIS Loads Lightened By One Assessment
Therapy questions could prove tricky.Come this fall, home health agencies could save a bit... Read more
Long-Term Care:
Many SNFs' Dual-Eligible Claims Not Up To Snuff
Here's what SNFs need to know to get things done right.Billing for patients with both Medi... Read more
Labs:
Blood Test Panels Now Under The OIG's Microscope
Allegedly padding panels with unneeded tests costs one lab $10 million.Labs could find tha... Read more
Prescription Drug Cards:
HHS Touts Rx Card Discounts As Web Site Goes Live
But will the cards save seniors enough money?With the Web site for the program live as of ... Read more
Enforcement:
Fraud Fighters Load Up With More Ammo
Every dollar spent on prosecution puts $13 back in federal treasury.With numbers like the ... Read more
Pharmaceuticals:
Another Drug Rebate Stumbling Block Removed
More states could come collecting if new information sharing pans out.Drug manufactures, b... Read more
DME:
It's The End Of The Road For SOIs
The Centers for Medicare Medicaid Services has sent statements of intent the way of the di... Read more
Program Transmittal Roundup
The HHS Office of Inspector General and the Centers for Medicare & Medicaid Services h... Read more
Dialysis:
For Dialysis Patients, Choose 'Fistula First'
New CMS program sings the praises of a safer, more cost-effective kind of access.Providers... Read more
Rehab:
Therapists Getting Caught In Stroke Coding Trap
Choosing the wrong diagnosis can lead to big problems.If outpatient therapy providers are ... Read more
Home Care:
OASIS Suspensions Add More Work For HHAs
Assessment time points added for some.The suspension of OASIS data collection for private ... Read more
Lab Tests:
CMS Clarifies Confusion On Physician Referrals
Find out when physician referrals are and are not acceptable.If you have been searching fo... Read more
Hospitals:
Higher Pay On The Way For Reclassified Hospitals
The list of qualifying facilities to be released soon on CMS' Web site.Good news for hospi... Read more
Health Plans:
New Rx Cards Shake Up Managed Medicare Market
Insurers hope to use the cards to drive business for Medicare Advantage products.Phase I o... Read more
Home Care:
CMS Grants Some Assessment Flexibility
The Centers for Medicare & Medicaid Services has thrown home health agencies one bone ... Read more
Chronic Care:
CMS Solicits Proposals For Care Coordination Pilot
Ten applicants wanted for 3-year pilot.The Centers for Medicare & Medicaid Services is... Read more
FDA:
FDA Approves Two New Cancer Drugs
Martha Stewart may be going to prison because she bet against ImClone's new cancer drug Er... Read more
Bill Watch
Bill introduced in the House: HR 4195. A bill to amend part D of title XVIII of the Social... Read more
Stark:
Docs Can Have Compensation Deals Under Stark
New Stark II regulation loosens some of the payment rules.There's good news for doctors wh... Read more
Coverage:
New Codes Coming For Bariatric Surgeries
Carrier loosens red tape on stomach-stapling and bypass operations.New policies from at le... Read more
Long-Term Care:
Flawed MDS Software Leading SNFs To Federal Audits
What SNFs' computers say about RUG categories could come back to haunt them.Sure, a skille... Read more
Oasis:
Surveyors Taking Closer Look At Wound Care Training
How accurate are HHAs' OASIS wound care answers?Heads up, home health agencies: OASIS woun... Read more
Rehab:
Rehab Providers Brace For More Doc-Owned Clinics As A Result Of Stark Reg
What therapists need to do to succeed under the rehab-unfriendly regulation.Phase II of th... Read more
Physicians:
Docs May Win Pay Hike Thanks To Lobbying On Hill
Thomas and Johnson are working to get more dollars to doctors.House Ways and Means Chair B... Read more
Hospitals:
Pacemaker Coverage Expands
CMS memo: "Pacemaker implantation is no longer an experimental procedure."Good news for pr... Read more
Medicaid:
Beware If Medicaid Foots The Bill For Inmate Care
Just because you provide services for inmates, that doesn't mean you too can break the law... Read more
Medicare Advantage:
MedPAC: Medicare Private Plans Cost More Than FFS
Health plans, now eager to join Medicare, dispute the findings.Medicare pays private plans... Read more
HOME CARE:
Stark II Fans Flames Of Patient Steering Controversy
Hospitals can require doctors to refer to their HHAs, rule says.The long-running grudge ma... Read more
MEDICAID:
Michigan Preferred Rx List Wins Appellate Blessing
State can leverage its Medicaid buying power for enrollees in state programs.A federal app... Read more
DME:
Beware Of Shared Employees Under Stark II
Will DME business practices pass Stark inspection.Watch out, DME suppliers: Kickback viola... Read more
PHARMACEUTICALS:
Date Set For Drugmakers To Hand Over Pricing Data
Government ready to ratchet up its scrutiny of Big Pharma.It's official: A new price repor... Read more
HEALTH SAVINGS ACCOUNTS:
What The New HSA Guidances Mean For Health PlansWhat The New HSA Guidances Mean For Health Plans
Implemented by the Medicare reform reg, the new HSAs could redefine health insurance.Healt... Read more
HOSPITALS:
Don't Miss Out On Special OPPS Reimbursement
The scoop on the latest pass-through payments for new drugs and technologies.A few more fi... Read more
LONG-TERM CARE:
Florida Homes Under Quality-Of-Care Scrutiny
Sanctioned facilities should beware of pocketing payments for new admitsIs improper Medica... Read more
DME:
Suppliers Seek Explanation For Wheelchair Coverage
Wheelchair forum barely scratches the surface of suppliers' concerns.Five hundred people c... Read more
Physicians:
McClellan Is To Docs As Scully Was To Hospitals?
New CMS administrator, with links to physicians, reaches out to embattled industry.In one ... Read more
Health Plans:
Medicare Plans Due For 6.6-Percent Raise in 2005
The good news means more plans may join Medicare Advantage in the future.Under payment rul... Read more
Hospitals:
Relief Arrives For Rural And Small Hospitals
Reform bill ushers in $12 billion over the next decade. Financially struggling hospitals i... Read more
Medicare Reform:
Employers Won't Get Medicare Drug Subsidy If They Shift Too Many Costs To Retirees
Earlier this year, the Wall Street Journal reported expert opinion suggesting that employe... Read more
Managed Care:
Are Plans Doing The Right Thing With BIPA Funding?
The OIG may be checking the record to make sure.Did your payment rates increase under the ... Read more
Hospitals:
Feds Want To Increase Heart Transplant Oversight
OIG calls for an overhaul of centers' centrification process.Heads up, heart transplant ce... Read more
Coverage:
Medicare Covers New Wound Care Treatment
Good news for therapists, home health agencies and patients.Home health patients with chro... Read more
Program Transmittal Roundup
Patients with chronic wounds may have a new source of treatment hope: electromagnetic ther... Read more
Bill Watch
The following bill was introduced in the House: HR 4054. A bill to require the establishm... Read more
Stark:
Here Comes The Final Piece Of The Stark Puzzle
What the much-anticipated Stark II, phase 2 rule means for you.The long-awaited second pha... Read more
Kickbacks:
Don't Be Fooled By Groundless Kickback Charges
Here's what you need to know about per-patient marketing compensation.A federal appeals co... Read more
4 Steps For Compliance Success
Attorney Mark Langdon with Arent Fox Kintner Plotkin & Khan in Washington recommends f... Read more
Prescription Drug Cards:
HHS Announces Rx Discount-Card Sponsors
Many health plans and PBMs hope the Rx card opens the door to big 2006 market.The Departme... Read more
Compliance:
What New Sentencing Guidelines Mean For COs
The HCCA fears compliance officers could be scapegoats for operational breakdowns.The Heal... Read more
Home Health:
HHAs Should Protect Reimbursements For Transfers
A little research can go a long way for home health agencies.One of the touchiest billing ... Read more
Pharmaceuticals:
How The Game May Change For Drug Rebates
What the hunt for lost state revenue means for drugmakers.Drug manufacturers need to gear ... Read more
DME:
Wheelchair Industry Wins Restriction Battle
But how will suppliers fare in the Wheeler Dealer war?Wheelchair suppliers, beneficiaries ... Read more
BILL WATCH
The following bill was introduced in the Senate: S 2234. A bill to amend title XVIII of th... Read more
Medicare Reform:
Scandal Over Withheld Information Plagues Medicare
CMS actuary says he was threatened with firing if he released numbers.Chief Medicare actua... Read more
DME:
5 Weapons Against Wheelchair Fraud
Suppliers brainstorm for Operation Wheeler Dealer relief.If beleaguered wheelchair supplie... Read more
Medicaid:
Panel Wants Medicaid Funds To Fund Medicaid
Federal government is being taken advantage of by states, panel says.How to make states ac... Read more
People:
McClellan Confirmed At CMS
Former FDA chief approved after contentious hearing on drug importation.It wasn't pretty, ... Read more
Long-Term Care:
The Lowdown On Latest SNF Staff Glitches
What you need to fine tune -- before the OIG does it for you.Nursing homes may have federa... Read more
Physicians:
What Never To Do If The Feds Come Knocking
Last-minute changes to patient records will only make things worse.There's a high price to... Read more
Physicians:
MedPAC Suggests Productivity Measures For Doc Pay
Recommendation would alter the way physician payment updates are calculated.In 2005 Medica... Read more
Reimbursement:
What The Future Holds For Your Medicare Payments
See how MedPAC's March 2004 Report to Congress will impact your bottom line.How will Congr... Read more
Home Care - No Fooling:
HHA Payment Cuts Due April 1
HHAs should end episodes now to secure higher payments.Good news for rural agencies but ba... Read more
Health Plans - GOP:
Consumerism Must Work, Or Single-Payer Health Care Will Be Inevitable
Health plans need to make the most of their good fortune, or else.Employers and others are... Read more
Managed Care:
Thanks, Taxpayers! What Health Plans Are Doing With Their Extra Medicare Pay
Plans creating larger networks, lowering premiums.Want to know how the playing field is sh... Read more
DME:
Suppliers Vent About Operation Wheeler Dealer
CMS still mum on possible remedies.Feelings were running high at a March 3 special listeni... Read more
Long-Term Care:
Beware Of Blurring Lines Between Related Companies
Related party rules can make Medicaid audits tricky.A recent HHS Office of Inspector Gener... Read more
Program Memo Roundup
The Centers for Medicare & Medicaid Services handed out marching orders to fiscal inte... Read more
Bill Watch
Bills introduced in the House: HR 3876. A bill to amend part C of title XVIII of the Socia... Read more
Medicaid:
HHS Agrees To Consult On Prescreening Spending
Federal government still may play bigger role in states' decisions than ever before.It was... Read more
Medicaid:
Is There A Slowdown On Medicaid Waivers?
Governors disagree about cooperativeness of federal government.There seems to be some part... Read more
Home Care:
M0175 Takebacks Could Be Only A Month Away
CMS official reveals M0175 recovery schedule for early PPS claims.Just because home health... Read more
Medicaid Discount Card:
CMS Will Update Drug-Card Price Data Every Week
Agency releases more details on oft-misunderstood drug-card policies.When Medicare prescri... Read more
Long-Term Care:
Auditors Will Be Watching Nursing Home Compare
Birmingham nursing home runs into a snag on almost-perfect audit.Nursing homes that toe th... Read more
PROGRAM MEMO ROUNDUP
Heads up, physicians: The Centers for Medicare & Medicaid Services has issued its firs... Read more
BILL WATCH
Bills introduced in the House: A severe outbreak of "Not In My Backyard" Syndrome spread t... Read more
Medicare Advantage:
Medicare Plans Must Win Back Skeptical Seniors
Benes who were 'abandoned' by M+COs in the past will need extra wooing.Health plans thinki... Read more
Hospitals:
What You Need To Know About Charging The Uninsured
HHS offers guidance, but hospitals still unclear on some points.Hospitals hoping for the D... Read more
People:
McClellan To Take Over CMS
It's official: Food and Drug Administration Commissioner Mark McClellan, MD, is President ... Read more
Hospice - Study:
Hospice Costs More Than Traditional Care
Could newly revealed data mean hospices will lose favor with regulators, lawmakers?A surpr... Read more
Budget:
Bracing Yourself For Another Balanced Budget Act?
Huge federal deficits could cost health care providers in the future.Budget cuts affecting... Read more
Enforcement:
You Could Soon Face An Even Stronger OIG
Congressional fraud hawks aren't backing down.A few long-time fraud hawks have a bone to p... Read more
HIPAA:
Will HIPAA Make Packrats Of Us All?
Think twice before deleting patient e-mailsProviders working with small computer systems h... Read more
Hospitals:
Numbers Up For Hospital Reporting Initiative
The carrot of Medicare reimbursement finally woos more hospitals to quality movement.A tot... Read more
Costs:
Spending Growth Peaked In 2002, CMS Predicts
But another peak might not be far off, and that's bad news for Medicare.When all the data ... Read more
Rehab:
CORFs Given New M+CO Appeals Responsibilities
5 tips for mastering notification requirements.New fast-track appeals requirements are cat... Read more
Home Care:
OIG OKs Copay Waiver On Diabetes Supplies
Follow these top attorneys' tips to make sure your copay waivers are legit.Home care provi... Read more
DME:
Feds Roll Over Wheelchair Operators
After Texas bust, more investigations are on the way, OIG promises.The jig is up for seven... Read more
Long-Term Care:
Are Long-Term Care Hospitals Doing Too Well?
Government probe wants CMS to re-evaluate record growth, profits.Big profits make big targ... Read more
Pharmaceuticals:
Watch For Tighter Medicaid Rebate Enforcement
AWP could shrink to AMOP after government pricing investigation.Drugmakers, you saw this o... Read more
Pharmaceuticals:
Drug Discount Cards Coming To Benes This Spring
Company-sponsored cards will ease waiting time for the DIMA drug benefit.It looks like you... Read more
Program Memo Roundup
Tired of getting conflicting advice from different intermediaries and carriers?Instead of ... Read more
Bill Watch
Bills introduced in the House and Senate: HR 3790. A bill to impose a moratorium on paymen... Read more
Medicare Advantage:
MedAdv Plans Lower Premiums, Enhance Benefits
Flush with federal funding, plans are making their products more attractive.Less than a mo... Read more
CMS Administration:
$1 Billion Not Enough To Implement New Law?
Responsible for revamping Medicare in two years, CMS is swamped.Saying that their agency i... Read more
Medicare Reform Law:
Momentum Builds To Reopen Medicare Law
Democrats want cheaper drugs, Republicans want cheaper Medicare.Two Senators who voted for... Read more
DME:
New Coalition Opposes Wheelchair Policy Changes
CMS tries to sneak in drastic changes through backdoor policy-making.The durable medical e... Read more
Home Care:
Home Care Cuts On The Horizon
Increased Medicare bill cost estimate puts HHAs at risk.Just when home health agencies are... Read more
Regulation:
Got A Beef With CMS? Make Yourself Heard
It's easier than ever to give your 2 cents' worth on CMS' proposals.Health care providers ... Read more
Politics:
GOP-Connected Firm Big Player On Medicare Ads
Are the new TV spots public service announcements or Bush reelectionAlexandria VA-based Na... Read more
Labs:
OIG Eyes State Lab Payment Policies
Audit could affect lab payments.The HHS Office of Inspector General says the state of Mass... Read more
Pharmaceuticals:
Reimbursement Rates For Popular Meds Under Fire
OIG report claims Medicare is paying higher rates, losing millions.Payments for widely use... Read more
Program Memo Roundup:
Program Memo Roundup:
The interest rate for Medicare overpayments and underpayments will remain steady at 12 per... Read more
Bill Watch:
Bill Watch:
Bill introduced in the House: HR 3711. A bill to amend the Medicare Prescription Drug, Imp... Read more
Medicare Reform Law:
Bush To Project Medicare Bill Over $530 Billion
Medicare reform to cost much more than originally projected.When it issues its budget on F... Read more
Medicare Reform Law:
Complexity For Consumers Is A Huge Hurdle
Success of new Medicare may depend on communication with beneficiaries.Offering Medicare b... Read more
Home Care:
New M+CO Appeals Burden Hits HHAs Hard
HHAs need to know what's required under the new mandate.Relationships between Medicare+Cho... Read more
Hospitals:
LTC Hospitals Next In Line For Pay Hike
Proposed rule answers call for fee updates, policy changes.Good things are in store for lo... Read more
Hospitals:
Beefed-Up Funding En Route To CAHs, Too
Rural providers get breathing room on beds, plus $900 million over next ten years.Good new... Read more
Long-Term Care:
Web Site Gives Public Look At SNF Performance
Nursing homes wondering how they'll look on CMS' enhanced "Nursing Home Compare."Wake-up c... Read more
Hospitals:
How Hospitals Can Avoid A Medicare Pay Cut
Submitting quality data is the key.Hospitals need to participate in CMS' quality reporting... Read more
Program Memo Roundup
The Centers for Medicare & Medicaid Services is restoring a pair of common working fil... Read more
Bill Watch
Bills introduced in the House: HR 3702. A bill to amend title XVIII of the Social Securit... Read more
Rehab:
Therapists Gain Leeway In Certification Process
Experts explain how therapists can take advantage of the new rule change.Obtaining physici... Read more
Medicare+Choice:
M+C Plans Receive Huge Funding Boost
10.6-percent increase could facilitate plans' reentry to Medicare.The Medicare program is ... Read more
Home Care:
HHAs Should Sharpen Their M0175 Skills
CMS backtracks on pledge to clean up HHAs' responses to tricky OASIS item.Back in November... Read more
Some HHAs Won't Be Penalized For OASIS Suspension
Other home care topics covered in CMS' home care forum include:   OASIS suspension. C... Read more
Rehab:
Medicare Act Holds Buried Treasure For Therapists
The therapy cap moratorium isn't the only good news for therapists.Therapists who have bee... Read more
Reimbursement:
2005 Provider Payment Forecast
What MedPAC has to say about the future of provider reimbursement.Hospitals will do well w... Read more
HIPAA:
Providers Clued In To One More HIPAA Standard
National Provider Identifier will replace all "legacy" IDs in 2005. Health care providers ... Read more
Program Memo Roundup
Physicians hassled by carriers who bungle claims for sacroiliac joint injection of anesthe... Read more
Bill Watch
Bill introduced in the House: HR 3722: A bill to amend section 1011 of the Medicare Prescr... Read more
Health Plans:
Health Plans Planning Their Moves Into Medicare
What managed care organizations are thinking as they prepare to remake Medicare.Medicare h... Read more
Home Care:
Some HHAs May Be Frozen Out Of Medicare
Increased managed care presence is bad news for home care industry.Home care providers are... Read more
DME:
Power Wheelchair Enforcement Continues
Fraud enforcement seeks out all players in lack of medical necessity casesThe long arm of ... Read more
DME Industry Defends Itself With Study Showing Benefits of Power Wheelchairs
The feds may be cracking down on claims for power wheelchairs, but mobility products do ha... Read more
Long-Term Care:
Staffing Requirements A Sticking Point With OIG
SNFs shouldn't risk their reps by falling a step short on training and hiring.Nursing faci... Read more
RURAL HEALTH:
New Rule Could Revoke Hospitals' RHC Status
CMS seeks to flush out certified clinics not offering true "expanded access."The Centers f... Read more
Big Changes May Loom For Surgical Reimbursement
Bad news for hospitals.            ... Read more
Pharmaceuticals
Rx Probe's Ever-Widening Net Reels In Big Retailers...House leaders want pharmacy chains t... Read more
Program Memo Roundup
The Centers for Medicare & Medicaid Services rang in the new year with a flurry of pro... Read more
Register Watch
Curious about what the Centers for Medicare & Medicaid Services expects of your Medica... Read more
Regulations:
DOZENS OF REGULATORY CHANGES IN THE PIPELINE
What's coming down the pike from CMS and the OIG. Medicare's regulatory framework is a fas... Read more
Physicians:
CMS RINGS IN THE NEW YEAR WITH PHYSICIAN PAY HIKE
Starting January 1, physicians can see it to believe it. Good news for physicians - the Me... Read more
Home Care:
NEW HOME CARE PPS RATES MAY CHANGE MORE THAN EXPECTED
HHAs prepare for inflation update revamp. The market basket index for home health agencies... Read more
Health Savings Accounts:
IRS ISSUES GUIDELINES FOR NEW TAX-FAVORED ACCOUNTS
The Internal Revenue Service in new guidelines outlines the broadly favorable tax treatmen... Read more
Medicare Rx:
REALITY: MEDICARE MAY NEED TO SET SOME Rx PRICES
Health economist Joseph Newhouse predicts that the Medicare prescription-drug law's "non-i... Read more
Medicare+Choice:
SENIORS IN FOR-PROFIT PLANS NOT DENIED HIGH-COST CARE
At least in the Medicare program, for-profit managed care plans provide as much access to ... Read more
Hospice:
COPs, Amendments On Hospice Horizon
Hospices have their fair share of regulatory action planned this year. According to the Ce... Read more
Pharmaceuticals:
CMS TACKLES AWP
In one of its first steps towards turning the sprawling Medicare legislation signed by Pre... Read more
People:
SMITH BECOMES ACTING CMS CHIEF
Former Centers for Medicare and Medicaid Services Administrator Tom Scully has joined the ... Read more
Medicare+Choice:
M+C 2004 ACRP TIMELINE
To be ready for the changes in March, M+COs need to act now. The Medicare Prescription Dru... Read more
Pharmaceuticals:
CMS BEEFS UP DRUGMAKER RECORDKEEPING RULE
Time limitation bumped up to 10 years. Drug makers will need to hold onto pricing and reba... Read more
Pharmaceuticals:
MEDICAID Rx SCRUTINY placed on DOCS, PHARMACISTS, PATIENTS
Watch for yet more investigation of suspected prescription drug fraud . Big players in the... Read more
Hospitals:
MORE LIFE SUPPORT FOR RURAL HOSPITALS
New rule secures cash flow to rural hospitals, changes payments on certain drugs. More tha... Read more
Hospitals:
SMALL TOWN HOSPITALS TO RECEIVE BIG-CITY WAGES
Special appeals for wage index classification are now under way. The Centers for Medicaid ... Read more
Self-Referral:
ITS THAT TIME OF YEAR - feds DELAY SELF REFERRAL RULE, AGAIN
Effective date for controversial Stark provision now July 7, 2004. In keeping with its thr... Read more
CMS MANUAL UPDATE
Physicians will be able to bill Medicare for HCPCS code J0880 starting Jan. 1, 2003, the C... Read more
Rehab:
PTs TOP CMS' LIST OF PROBLEM BILLERS
But are therapists taking the blame for other providers' mistakes?  Physical therapis... Read more
Managed Care:
MEDICARE Rx BILL PUTS PBMs, HEALTH PLANS ON HOOK FOR COSTS
Will the Medicare prescription drug benefit lead to greater drug expenses for plans?Health... Read more
Home Care:
PRIVATE-PAY OASIS POLICIES MUST BE BASED ON THE WRITTEN WORD
CMS letter to surveyors fails to clear up confusion.A new letter to state surveyors suppos... Read more
Home Care:
NEW SIGNATURE STANDARD HELPS HHAs GET DOC ORDERS QUICKLY
But it doesn't apply to CMNs.As home health agencies ring in the new year, they can also c... Read more
Home Care:
5 TIPS FOR E-SIGNATURE SECURITY
Stamped signatures aren't the only alternative to speed orders.Home care providers looking... Read more
Medicaid:
MENTAL HEALTH GROUPS, ER DOCS RAISE ALARM ON MEDICAID CUTS
But more cuts likely to follow as states grapple with deficits.Mentally ill patients alrea... Read more
Hospitals:
HOSPITALS CAN COLLECT MORE FOR QIO PHOTOCOPYING
After more than a decade, CMS ups hospitals' photocopying reimbursement.Hospitals will be ... Read more
Hospitals:
WHY HOSPITAL-DOC ARRANGEMENTS CAN BE COMPLIANCE TIME-BOMBS
3 risk areas to watch for.          &nbs... Read more
Exclusions:
TENET FORCED TO SELL REDDING MEDICAL CENTER
Hospital chain and OIG come to terms on potential Medicare ouster.The HHS Office of Inspec... Read more
Medicare+Choice:
A NEW WAY TO LURE BENEFICIARIES INTO MEDICARE+CHOICE
M+COs get another benefit option. Health plans often have a hard time encouraging Medicare... Read more
HIPAA:
TOP 9 HIPAA TRANSACTIONS RULE MISTAKES
Most Medicare claims aren't HIPAA compliant. It's a good thing the Centers for Medicare &a... Read more
ANOTHER SHAKEUP AT HHS?
Thompson may step down next year.If President Bush is re-elected next year, he'll have to ... Read more
Medicare:
CMS ISSUES DRUG DISCOUNT CARD RULE
Experts debate whether seniors will flock to the temporary cards.  On Dec. 10, only t... Read more
Rehab:
CARDIAC REHAB AUDIT SHOWS PROVIDERS SKIPPING A BEAT
What all rehab provider types can learn from outpatient cardiac mistakes.  Outpatient... Read more
Self-Referral:
REFORM BILL TAKES AIM AT DOC-OWNED SPECIALTY HOSPITALS
Will a cash cow be put out to pasture?  A lucrative investment opportunity for p... Read more
Long-Term Care:
HOW THE REVAMPED MEDICARE WILL IMPACT SNFs
President Bush has signed into law the largest Medicare overhaul in history - and it's ti... Read more
Home Care:
MEDPAC PEGS HHA PROFIT MARGIN AT 17%
Home care benefit drops chronically ill patients, research shows.  If the Medica... Read more
Long-Term Care:
SNFs SHOULD BE MAKING THEIR LIST AND CHECKING IT TWICE
New Medicare legislation beefs up employee background check requirements.  Skilled nu... Read more
EMTALA:
PROVIDERS GET RELIEF ON EMTALA MANDATE
ER care for illegal immigrants doesn't have to be a total loss.  Hospitals and p... Read more
Whistleblowers:
BEWARE STATE WHISTLEBLOWER LAWS
In some states, whistleblowers can pursue you on state and federal grounds.  Whistleb... Read more
Ambulance:
SAY GOODBYE TO RURAL TRANSITIONAL ASSISTANCE
On the other hand, say hello to a 2.1 percent cost-of-doing-business increase.  Ambul... Read more
CMS MANUAL UPDATE
Thanks to the recently enacted Medicare prescription drug legislation, providers of therap... Read more
Home Health:
HHA PAYMENT CUT SLATED FOR APRIL
Medicare bill a mixed bag for HHAs.  It will take experts months to suss out the rece... Read more
Rehab:
CONGRESS PUTS A CAP IN THE THERAPY CAPS
Thanks to rehab providers' tireless lobbying efforts, they can kiss the much-maligned ther... Read more
Payment Errors:
ARE PAYMENT ERRORS WORSE THAN CMS SAYS?
Senate fraud hawk chides CMS with tinkering with error figures.  Health care pro... Read more
Disease Management:
TRIO OF HEALTH PLANS TAPPED FOR MEDICARE DM PILOT
Will disease management find a happy home in Medicare?  Health plans that haven't yet... Read more
DME:
SUPPLIERS BID FAREWELL TO ANTI-BIDDING HOPES
No good news for DME in newly passed legislation.  The new prescription drug benefit ... Read more
Rehab:
REHAB PROVIDERS CHEER FEE SCHEDULE FIX
2004 physician fee schedule speaks to PT-OT-and SLP-specific issues.  Congress stepp... Read more
Psychiatric Facilities:
7 KEY ELEMENTS OF THE INPATIENT PSYCH FACILITY PPS PROPOSAL
2,000 psychiatric hospitals and units brace for a new reimbursement era. Yet another clas... Read more
People:
SCULLY TO STEP DOWN
Tom Scully is leaving his post as Centers for Medicare & Medicaid Services Administra... Read more
Labs:
LAB FRAUD FIGHTERS CAST A WIDE NET
Golden State lab operator snared in $1.3 million fraud. When it comes to health care fraud... Read more
Labs:
THE WRONG INSTRUCTIONS COULD LEAD TO A CLIA CITATION
What labs should watch for on tests that could be waived or moderate complexity. ... Read more
BILL WATCH
The following bill was introduced in the Senate before it adjourned for the holidays: S. ... Read more
CME MANUAL UPDATE
Providers of ambulance services can gain a bit of insight into how carriers calculate the ... Read more
Available Years:  2004  2003