Medicare Compliance & Reimbursement
Health IT:
Feds Propose New Disincentives For Information Blocking
Warning: Medicare providers are the target demographic. Since the 21st Century Cures Act ... Read more
Feds Propose New Disincentives For Information Blocking
Warning: Medicare providers are the target demographic. Since the 21st Century Cures Act ... Read more
Compliance:
Get A Grip On Holiday Gifting Rules
Plus: Protect your practice with compliant policies. The old saying goes: “Tis better... Read more
Get A Grip On Holiday Gifting Rules
Plus: Protect your practice with compliant policies. The old saying goes: “Tis better... Read more
Circumvent Gifting Violations With These 6 Tactics
Don't let common gift-giving practices get you into hot water. Reduce your risk during th... Read more
Don't let common gift-giving practices get you into hot water. Reduce your risk during th... Read more
Part B Coding Coach:
Bolster Flu Vaccine Coding Knowledge With These Updates
Bonus: Pocket the flu code chart for reference. The onset of flu season brings new vacci... Read more
Bolster Flu Vaccine Coding Knowledge With These Updates
Bonus: Pocket the flu code chart for reference. The onset of flu season brings new vacci... Read more
Clip And Save:
Tackle Roster Billing Set-Up With 6 Quick Steps
Tip: Know the vaccination types available for roster billing. Every year, Medicare prov... Read more
Tackle Roster Billing Set-Up With 6 Quick Steps
Tip: Know the vaccination types available for roster billing. Every year, Medicare prov... Read more
Reader Question:
Know The Facts on JZ Modifier Usage
Question: Even though modifier JZ was introduced last January, we're a little confuse... Read more
Know The Facts on JZ Modifier Usage
Question: Even though modifier JZ was introduced last January, we're a little confuse... Read more
Reimbursement:
CMS Opts For Punishing CF Cut In 2024
Add-on code, regulatory requirements factor into final decrease. Despite rising costs, in... Read more
CMS Opts For Punishing CF Cut In 2024
Add-on code, regulatory requirements factor into final decrease. Despite rising costs, in... Read more
Policy:
Register These 4 Fee Schedule High Points
See how telehealth services continue to evolve post-PHE. As the healthcare industry mov... Read more
Register These 4 Fee Schedule High Points
See how telehealth services continue to evolve post-PHE. As the healthcare industry mov... Read more
Part B Coding Coach:
Here’s The Scoop On COVID-19 Vax Coding Updates
Figure out which code survived the chopping block. Although the COVID-19 public health ... Read more
Here’s The Scoop On COVID-19 Vax Coding Updates
Figure out which code survived the chopping block. Although the COVID-19 public health ... Read more
Reader Question:
Understand How Taxonomy Codes Affect Medicare Pay
Question: I have never heard of taxonomy beyond the categorization of species, and no... Read more
Understand How Taxonomy Codes Affect Medicare Pay
Question: I have never heard of taxonomy beyond the categorization of species, and no... Read more
Reader Question:
Find Out What An ‘Independent Historian’ Refers To In Healthcare
Question: I am working as a coder for the first time and one of my providers wrote th... Read more
Find Out What An ‘Independent Historian’ Refers To In Healthcare
Question: I am working as a coder for the first time and one of my providers wrote th... Read more
Reader Question:
What Is ‘Vendor Lock-In?’ Find Out
Question: We recently heard the term ‘vendor lock-in' and thought it sounded rather... Read more
What Is ‘Vendor Lock-In?’ Find Out
Question: We recently heard the term ‘vendor lock-in' and thought it sounded rather... Read more
HIPAA:
Don’t Skimp On Sanction Policymaking, Feds Warn
Tip: Ensure employees receive training equivalent to their duties. When a data breach oc... Read more
Don’t Skimp On Sanction Policymaking, Feds Warn
Tip: Ensure employees receive training equivalent to their duties. When a data breach oc... Read more
Add HC3 Resources To Your Cybersecurity Toolkit
Whether you're a data security novice or have always prioritized cyber hygiene, you should... Read more
Whether you're a data security novice or have always prioritized cyber hygiene, you should... Read more
Part B Coding Coach:
Eye Care: Sidestep Cataract Surgery Snafus With Documentation Advice
Tip: Beef up chart notes with knowledge of 5 critical items. Because cataract surgery con... Read more
Eye Care: Sidestep Cataract Surgery Snafus With Documentation Advice
Tip: Beef up chart notes with knowledge of 5 critical items. Because cataract surgery con... Read more
Compliance:
Cataract Surgery Remains Popular Medical Review Topic
Find out the codes the MACs are targeting in their TPE reviews. Cataract surgery claims c... Read more
Cataract Surgery Remains Popular Medical Review Topic
Find out the codes the MACs are targeting in their TPE reviews. Cataract surgery claims c... Read more
Industry Notes:
Use The Updated CMS-855I Form, MAC Reminds
If your practice is still using paper applications to enroll or update Medicare provider e... Read more
Use The Updated CMS-855I Form, MAC Reminds
If your practice is still using paper applications to enroll or update Medicare provider e... Read more
Industry Notes:
House GOP Doctors Aim To Bump Up CF By 2025
Budget neutrality mandates are at the heart of the annual Medicare conversion factor crunc... Read more
House GOP Doctors Aim To Bump Up CF By 2025
Budget neutrality mandates are at the heart of the annual Medicare conversion factor crunc... Read more
Fraud & Abuse:
Feds Fixate On Physicians In October Enforcement
Medicare fraud schemes abound in latest round of settlements. As the year winds down, enf... Read more
Feds Fixate On Physicians In October Enforcement
Medicare fraud schemes abound in latest round of settlements. As the year winds down, enf... Read more
CPT® 2024:
Prep For These E/M Descriptor Revisions
Understand how Medicare policy factors into the equation. On Sept. 8, the American Medica... Read more
Prep For These E/M Descriptor Revisions
Understand how Medicare policy factors into the equation. On Sept. 8, the American Medica... Read more
Part B Coding Coach:
Circumvent Smoking Cessation Coding Concerns With This Primer
Utilize Medicare guidance for coverage questions. About 30 to 50 percent of smokers in... Read more
Circumvent Smoking Cessation Coding Concerns With This Primer
Utilize Medicare guidance for coverage questions. About 30 to 50 percent of smokers in... Read more
Industry Notes:
Feds Opt To Decrease AIC Rate For Judicial Review
If inflation has hit your practice hard, we've got some good news for you on Medicare app... Read more
Feds Opt To Decrease AIC Rate For Judicial Review
If inflation has hit your practice hard, we've got some good news for you on Medicare app... Read more
Industry Notes:
HRSA Continues To Recoup PRF Relief Funds
As more reporting period deadlines for CARES Act Provider Relief Funds (PRF) approach, pro... Read more
HRSA Continues To Recoup PRF Relief Funds
As more reporting period deadlines for CARES Act Provider Relief Funds (PRF) approach, pro... Read more
Industry Notes:
Medicare Offers New Enrollment Guidance For MFTs and MHCs For CY 2024
If you're a Marriage and Family Therapist (MFT) or Mental Health Counselor (MHC) and are c... Read more
Medicare Offers New Enrollment Guidance For MFTs and MHCs For CY 2024
If you're a Marriage and Family Therapist (MFT) or Mental Health Counselor (MHC) and are c... Read more
Reader Question:
Know This Detail on Redeterminations
Question: We are getting really close to the 120-day deadline to submit a redetermina... Read more
Know This Detail on Redeterminations
Question: We are getting really close to the 120-day deadline to submit a redetermina... Read more
Quality Payment Program:
Figure Out PY 2023 MVP Registration and Reporting Pronto
Tip: Keep tabs on your MVP status through the registration end date. The clock is ticking... Read more
Figure Out PY 2023 MVP Registration and Reporting Pronto
Tip: Keep tabs on your MVP status through the registration end date. The clock is ticking... Read more
MIPS Value Pathways 2023:
Review These Handy Charts for MVP Insight
Understand the basics on choosing the right MVP for your practice. Though your final ap... Read more
Review These Handy Charts for MVP Insight
Understand the basics on choosing the right MVP for your practice. Though your final ap... Read more
Part B Coding Coach:
Improve Stroke Coding Accuracy With These Tips
Focus on choosing the correct ICD-10-CM code for each patient. Providers utilize myriad d... Read more
Improve Stroke Coding Accuracy With These Tips
Focus on choosing the correct ICD-10-CM code for each patient. Providers utilize myriad d... Read more
Reader Questions:
Reach Out to MACs for Claims-Based NCCI Quandaries
Question: Which agency is most appropriate to contact if I have questions about an appeal ... Read more
Reach Out to MACs for Claims-Based NCCI Quandaries
Question: Which agency is most appropriate to contact if I have questions about an appeal ... Read more
Reader Questions:
Recognize the 2 Standards for De-Identifying PHI
Question: We are having a debate in our practice over what actually constitutes protected... Read more
Recognize the 2 Standards for De-Identifying PHI
Question: We are having a debate in our practice over what actually constitutes protected... Read more
Industry Notes:
OIG Doubles Down on Dx Miscoding Mishaps in Part C
Expect greater scrutiny as feds look at chart review results. Evidenced by numerous rep... Read more
OIG Doubles Down on Dx Miscoding Mishaps in Part C
Expect greater scrutiny as feds look at chart review results. Evidenced by numerous rep... Read more
No Surprises Act:
See Latest Twist on Independent Dispute Resolutions
Court decision causes Federal IDR process operations suspension. Since lawmakers announce... Read more
See Latest Twist on Independent Dispute Resolutions
Court decision causes Federal IDR process operations suspension. Since lawmakers announce... Read more
Diabetes Management:
Know These 4 Diabetes-Related Policies and Updates
Plus: See the latest fee schedule proposals on the MDPP. With a third of Medicare benefic... Read more
Know These 4 Diabetes-Related Policies and Updates
Plus: See the latest fee schedule proposals on the MDPP. With a third of Medicare benefic... Read more
Part B Coding Coach:
Bolster Diabetes Coding With Handy Q&A Set
Tip: Review ICD-10-CM guidelines to enhance claims success. Medicare providers treat pat... Read more
Bolster Diabetes Coding With Handy Q&A Set
Tip: Review ICD-10-CM guidelines to enhance claims success. Medicare providers treat pat... Read more
Industry Notes:
Ensure Billing Partners Are Using IVR Tools, MAC Urges
If the companies and agencies you utilize to do your Medicare billing aren't using the Int... Read more
Ensure Billing Partners Are Using IVR Tools, MAC Urges
If the companies and agencies you utilize to do your Medicare billing aren't using the Int... Read more
Industry Notes:
OCR Proposes New Rule Addressing Discrimination and Disability
The Department of Health and Human Services (HHS) looks to fortify section 504 of the Reha... Read more
OCR Proposes New Rule Addressing Discrimination and Disability
The Department of Health and Human Services (HHS) looks to fortify section 504 of the Reha... Read more
Industry Notes:
Don’t Let Modifier Snafus Impact E/M Claims
One Baltimore-based oncology practice learned the hard way that the feds don't mess around... Read more
Don’t Let Modifier Snafus Impact E/M Claims
One Baltimore-based oncology practice learned the hard way that the feds don't mess around... Read more
Reader Questions:
Pocket the Facts on PHEs
Question: Are all public health emergencies (PHEs) the same? Do they carry the same f... Read more
Pocket the Facts on PHEs
Question: Are all public health emergencies (PHEs) the same? Do they carry the same f... Read more
Quality Payment Program:
Expect More Requirements, Transparency for QPP 2024
Negative payment adjustments will hit small practices hardest, industry insiders warn. Fo... Read more
Expect More Requirements, Transparency for QPP 2024
Negative payment adjustments will hit small practices hardest, industry insiders warn. Fo... Read more
Reimbursement:
Boost Non-PAR Smarts With These 3 Steps
Understand the nuances of identifying as a non-participating practice. Practices that d... Read more
Boost Non-PAR Smarts With These 3 Steps
Understand the nuances of identifying as a non-participating practice. Practices that d... Read more
Documentation:
Shore Up Query Smarts With This Insight
Navigate provider interactions with ease. Realizing you need clarification from a provid... Read more
Shore Up Query Smarts With This Insight
Navigate provider interactions with ease. Realizing you need clarification from a provid... Read more
Part B Coding Coach:
Foot Care: Manage Pedorthic- Related Questions With This Primer
Caution: Be aware of documentation requirements when billing Medicare. If you are consid... Read more
Foot Care: Manage Pedorthic- Related Questions With This Primer
Caution: Be aware of documentation requirements when billing Medicare. If you are consid... Read more
Industry Notes:
Feds Settle FCA Allegations for $6.5 Million
Case serves as a stern reminder on medical necessity. Over the past few years, the feds... Read more
Feds Settle FCA Allegations for $6.5 Million
Case serves as a stern reminder on medical necessity. Over the past few years, the feds... Read more
Medicare Shared Savings Program:
CY 2024 Proposals Focus on Intersection of Quality, Technology, and Value
CMS' policies promote ‘whole-person care.' With a major overhaul to the Medicare Shared... Read more
CY 2024 Proposals Focus on Intersection of Quality, Technology, and Value
CMS' policies promote ‘whole-person care.' With a major overhaul to the Medicare Shared... Read more
ICD-10-CM:
Check Out Critical 2024 ICD-10-CM Updates
Review new options in neurology, cardiology, and more. With hundreds of new diagnosis cod... Read more
Check Out Critical 2024 ICD-10-CM Updates
Review new options in neurology, cardiology, and more. With hundreds of new diagnosis cod... Read more
Factor in This Claims Insight to Better Ensure Appropriate Pay
The Centers for Medicare & Medicaid Services (CMS) and many other payers use ICD-10-CM... Read more
The Centers for Medicare & Medicaid Services (CMS) and many other payers use ICD-10-CM... Read more
Clip And Save:
Add These 10 Patient Eligibility Tips to Your Wheelhouse
Don't forget about Medicare Secondary Payer rules. Pocket these tips to make patient insu... Read more
Add These 10 Patient Eligibility Tips to Your Wheelhouse
Don't forget about Medicare Secondary Payer rules. Pocket these tips to make patient insu... Read more
Reader Questions:
Know the Facts on Sharing Family Medical History
Question: When we inquire about patients' family medical history, is that information pro... Read more
Know the Facts on Sharing Family Medical History
Question: When we inquire about patients' family medical history, is that information pro... Read more
Reader Questions:
Figure Out When Medicare Is the Primary Payer
Question: One of our patients has Medicare but is also insured through a group help plan f... Read more
Figure Out When Medicare Is the Primary Payer
Question: One of our patients has Medicare but is also insured through a group help plan f... Read more
Industry Notes:
Sidestep Paper Claim Delays With MAC Insight
If you're wondering why your Medicare claims aren't getting processed properly, it could b... Read more
Sidestep Paper Claim Delays With MAC Insight
If you're wondering why your Medicare claims aren't getting processed properly, it could b... Read more
Industry Notes:
Targeted Review Is Now Available for MIPS Payment Year 2024
Mistakes happen. So, if you think there's a problem with your Merit-Based Incentive Paymen... Read more
Targeted Review Is Now Available for MIPS Payment Year 2024
Mistakes happen. So, if you think there's a problem with your Merit-Based Incentive Paymen... Read more
Industry Notes:
Don’t Miss the COVID Relief Fund Reporting Period 5 Deadline
Though the feds ended the COVID-19 Provider Relief Fund (PRF) disbursements, that doesn't ... Read more
Don’t Miss the COVID Relief Fund Reporting Period 5 Deadline
Though the feds ended the COVID-19 Provider Relief Fund (PRF) disbursements, that doesn't ... Read more
Medicare Physician Fee Schedule:
CMS Proposes Big CF Cut … Again
But: Some specialties may end up on the plus side for CY 2024. Complex calculations and f... Read more
CMS Proposes Big CF Cut … Again
But: Some specialties may end up on the plus side for CY 2024. Complex calculations and f... Read more
Check Out CF Adjustments Over the Last 5 Years
If you've seen your Medicare pay dwindling over the past few years, this may have been a c... Read more
If you've seen your Medicare pay dwindling over the past few years, this may have been a c... Read more
Reimbursement:
E/M Add-On Code May Offer Some Specialties a Pay Bump
Find out if you're expected to see an increase for CY 2024. Due to a separate add-on cod... Read more
E/M Add-On Code May Offer Some Specialties a Pay Bump
Find out if you're expected to see an increase for CY 2024. Due to a separate add-on cod... Read more
Policy:
Park These 4 Proposals on Your CY 2024 MPFS Watchlist
SDoH, telehealth factor heavily in latest iteration. Even though the COVID-19 public he... Read more
Park These 4 Proposals on Your CY 2024 MPFS Watchlist
SDoH, telehealth factor heavily in latest iteration. Even though the COVID-19 public he... Read more
Part B Coding Coach:
Urology: Boost Stent Placement Coding With This Primer
Plus: MAC found a 59% error rate for 52332 — find out why before it's too late Physici... Read more
Urology: Boost Stent Placement Coding With This Primer
Plus: MAC found a 59% error rate for 52332 — find out why before it's too late Physici... Read more
Industry Notes:
Tracking Tech Threatens Patients’ Privacy and Security, Feds Warn
Watch out: OCR and FTC remind providers about third-party, vendor issues. Technology has ... Read more
Tracking Tech Threatens Patients’ Privacy and Security, Feds Warn
Watch out: OCR and FTC remind providers about third-party, vendor issues. Technology has ... Read more
HIPAA Round-Up:
Feds Ramp Up Enforcement Post-PHE
OCR settles a cornucopia of cases in mid-year sweep. The first half of 2023 was relativel... Read more
Feds Ramp Up Enforcement Post-PHE
OCR settles a cornucopia of cases in mid-year sweep. The first half of 2023 was relativel... Read more
Quality Payment Program:
Strengthen MIPS 2023 Smarts With This Small Practice Primer
Tip: Utilize the plethora of tools and flexibilities CMS offers. Whether you've been all-... Read more
Strengthen MIPS 2023 Smarts With This Small Practice Primer
Tip: Utilize the plethora of tools and flexibilities CMS offers. Whether you've been all-... Read more
Part B Coding Coach:
Figure Out How to Code for Virtual Care
Tip: Ensure documentation supports the codes. You may be scratching your head over how b... Read more
Figure Out How to Code for Virtual Care
Tip: Ensure documentation supports the codes. You may be scratching your head over how b... Read more
Reader Questions:
Know These Important Facts on PSA Tests for Screening or Diagnosis
Question: A 66-year-old male patient was complaining of frequent urination during his annu... Read more
Know These Important Facts on PSA Tests for Screening or Diagnosis
Question: A 66-year-old male patient was complaining of frequent urination during his annu... Read more
Industry Notes:
See What One MAC Advises on Addendums
Hint: Clear and concise documentation and timeliness are key components. If you're confus... Read more
See What One MAC Advises on Addendums
Hint: Clear and concise documentation and timeliness are key components. If you're confus... Read more
Advance Care Planning:
Bolster ACP Billing With These 5 Q&As;
Tip: Understand both time and policy parameters to ensure clean claims. Discussing end-o... Read more
Bolster ACP Billing With These 5 Q&As;
Tip: Understand both time and policy parameters to ensure clean claims. Discussing end-o... Read more
Covid-19 Follow-Up:
Feds Nix Possibility of Future Provider Relief Funds
Update: Debt ceiling agreement abruptly ends COVID relief program. If you were holding o... Read more
Feds Nix Possibility of Future Provider Relief Funds
Update: Debt ceiling agreement abruptly ends COVID relief program. If you were holding o... Read more
Part B Coding Coach:
Radiology Coding: Perfect X-Ray Coding With View-Type Prowess
Tip: Review view definitions and anatomy to help with code choice. Radiologists capture ... Read more
Radiology Coding: Perfect X-Ray Coding With View-Type Prowess
Tip: Review view definitions and anatomy to help with code choice. Radiologists capture ... Read more
Reader Questions:
Know the Facts on Error Percentages and TPE Review
Question: Is there a specific denial percentage for a service that Medicare looks for when... Read more
Know the Facts on Error Percentages and TPE Review
Question: Is there a specific denial percentage for a service that Medicare looks for when... Read more
Reader Questions:
Get a Grip on Fingerstick Reimbursement
Question: Our lab collects capillary blood by fingerstick for certain tests rather than ve... Read more
Get a Grip on Fingerstick Reimbursement
Question: Our lab collects capillary blood by fingerstick for certain tests rather than ve... Read more
Industry Notes:
MIPS 2022 Preview Window Now Open
With costs on the rise, every penny counts. That includes money your practice receives fro... Read more
MIPS 2022 Preview Window Now Open
With costs on the rise, every penny counts. That includes money your practice receives fro... Read more
Industry Notes:
SAMHSA Offers New Long COVID Resource
Many patients continue to deal with both the physical and mental effects of COVID-19 long ... Read more
SAMHSA Offers New Long COVID Resource
Many patients continue to deal with both the physical and mental effects of COVID-19 long ... Read more
Industry Notes:
Fortify Emergency Response Policies With Federal Resources
The COVID-19 public health emergency (PHE) might be over, but that doesn't mean your pract... Read more
Fortify Emergency Response Policies With Federal Resources
The COVID-19 public health emergency (PHE) might be over, but that doesn't mean your pract... Read more
Industry Notes:
Regulatory Saga for Medicare Coverage of Emerging Tech Continues
With twists and turns aplenty, the Centers for Medicare & Medicaid Services (CMS) has ... Read more
Regulatory Saga for Medicare Coverage of Emerging Tech Continues
With twists and turns aplenty, the Centers for Medicare & Medicaid Services (CMS) has ... Read more
Enforcement:
Opioid Fraud Continues to Run Rampant, Report Shows
Caution: AKS issues remain an OIG sticking point. With the pandemic largely in the rearv... Read more
Opioid Fraud Continues to Run Rampant, Report Shows
Caution: AKS issues remain an OIG sticking point. With the pandemic largely in the rearv... Read more
COVID-19:
Feds Reel Back COVID Vax Mandate for Providers
But: State and local laws may still be a factor. If you're still operating off the old C... Read more
Feds Reel Back COVID Vax Mandate for Providers
But: State and local laws may still be a factor. If you're still operating off the old C... Read more
CDC Removes Some COVID Data Post-PHE
With the COVID-19 public health emergency (PHE) over for more than a month, it's not surpr... Read more
With the COVID-19 public health emergency (PHE) over for more than a month, it's not surpr... Read more
Part B Coding Coach:
ED: Wrap Up Wound Repair With This Expert Advice
Know the facts on components, complexity, and more. When patients present to the emerge... Read more
ED: Wrap Up Wound Repair With This Expert Advice
Know the facts on components, complexity, and more. When patients present to the emerge... Read more
Industry Notes:
Feds Continue to Focus on COVID Fraud Enforcement
The COVID-19 public health emergency (PHE) ended on May 11, but federal enforcement of COV... Read more
Feds Continue to Focus on COVID Fraud Enforcement
The COVID-19 public health emergency (PHE) ended on May 11, but federal enforcement of COV... Read more
Industry Notes:
Know These Revalidation Details
If you think that your Medicare provider revalidation process is complete once you submit ... Read more
Know These Revalidation Details
If you think that your Medicare provider revalidation process is complete once you submit ... Read more
Industry Notes:
Pocket These CY 2024 ACO Participation Deadline Specifics
Do you plan on or are you interested in participating in an Accountable Care Organization ... Read more
Pocket These CY 2024 ACO Participation Deadline Specifics
Do you plan on or are you interested in participating in an Accountable Care Organization ... Read more
Industry Notes:
WHO Urges Providers to Use Caution Before Utilizing AI
With the growth in development and adoption of AI across healthcare in recent months, the... Read more
WHO Urges Providers to Use Caution Before Utilizing AI
With the growth in development and adoption of AI across healthcare in recent months, the... Read more
Compliance:
Feds Offer Stern Reminder on EMTALA
CMS investigations highlight state and federal differences — and enforcement under the ... Read more
Feds Offer Stern Reminder on EMTALA
CMS investigations highlight state and federal differences — and enforcement under the ... Read more
HIPAA:
Understand How HIPAA Factors Into the Post-Dobbs Debate
OCR aims to protect both providers and patients in latest proposals. The feds want to en... Read more
Understand How HIPAA Factors Into the Post-Dobbs Debate
OCR aims to protect both providers and patients in latest proposals. The feds want to en... Read more
Part B Coding Coach:
Vision Care: Sidestep Ophthalmoscopy Reporting Blunders With This Insight
Tip: Figure out which claims require a written interpretation of the retinal imaging. De... Read more
Vision Care: Sidestep Ophthalmoscopy Reporting Blunders With This Insight
Tip: Figure out which claims require a written interpretation of the retinal imaging. De... Read more
Industry Notes:
CMS Set to Archive QPP Materials for PYs’ 2017-2020
With changes aplenty to the Quality Payment Program (QPP) in the years ahead, it shouldn't... Read more
CMS Set to Archive QPP Materials for PYs’ 2017-2020
With changes aplenty to the Quality Payment Program (QPP) in the years ahead, it shouldn't... Read more
Industry Notes:
Physician Gets Fine and 6 Years in Prison for Healthcare Fraud
The feds continue to levy significant convictions and penalties against fraudsters — and... Read more
Physician Gets Fine and 6 Years in Prison for Healthcare Fraud
The feds continue to levy significant convictions and penalties against fraudsters — and... Read more
Industry Notes:
Know the Facts on PRF Spending Post-PHE
If you have unspent Provider Relief Funds (PRF), you may not have to necessarily stop spen... Read more
Know the Facts on PRF Spending Post-PHE
If you have unspent Provider Relief Funds (PRF), you may not have to necessarily stop spen... Read more
Reader Questions:
Know the Timeline and Circumstance for Medicare Overpayments
Question: Who is responsible for identifying and correcting overpayment in any Center... Read more
Know the Timeline and Circumstance for Medicare Overpayments
Question: Who is responsible for identifying and correcting overpayment in any Center... Read more
Health IT:
Feds Propose Follow-Up to ‘Cures Act’ Rule
Data exchange, EHR requirements, and HIPAA factor into proposals. If you think that the ... Read more
Feds Propose Follow-Up to ‘Cures Act’ Rule
Data exchange, EHR requirements, and HIPAA factor into proposals. If you think that the ... Read more
Compliance:
Get Ready for an Overhaul of OIG’s Compliance Guidance
Hint: MA plans are first on the federal watchdog's update list. With most federal health... Read more
Get Ready for an Overhaul of OIG’s Compliance Guidance
Hint: MA plans are first on the federal watchdog's update list. With most federal health... Read more
Part B Coding Coach:
Conquer 4 Summer Calamities With Coding Insight
Beef up your claim with the right diagnosis codes. With spring in full swing and summer ... Read more
Conquer 4 Summer Calamities With Coding Insight
Beef up your claim with the right diagnosis codes. With spring in full swing and summer ... Read more
Industry Notes:
Get the Facts on the 6 Phases of HIPAA Administrative Simplification Complaint Process
Tip: Take advantage of CMS' compliance resources. Whether you want to lodge a complaint... Read more
Get the Facts on the 6 Phases of HIPAA Administrative Simplification Complaint Process
Tip: Take advantage of CMS' compliance resources. Whether you want to lodge a complaint... Read more
Reader Question:
Bolster Your Coding Game With This Multiple Modifier Advice
Question: We have a small practice in a designated health professional shortage area ... Read more
Bolster Your Coding Game With This Multiple Modifier Advice
Question: We have a small practice in a designated health professional shortage area ... Read more
Policy:
CMS Aims to Align MA With Traditional Medicare
Final rule cuts administrative burdens while increasing oversight. As the feds exit pand... Read more
CMS Aims to Align MA With Traditional Medicare
Final rule cuts administrative burdens while increasing oversight. As the feds exit pand... Read more
Part B Coding Coach:
ICD-10-CM: Conquer Incontinence Coding With These Terminology Tips
Know the difference between ‘urge' and ‘stress' incontinence. Reporting correct and ... Read more
ICD-10-CM: Conquer Incontinence Coding With These Terminology Tips
Know the difference between ‘urge' and ‘stress' incontinence. Reporting correct and ... Read more
Clip And Save:
Update Medicare Provider Enrollment to Avoid PTAN and NPI Issues
Critical: Ensure your PTAN hasn't been deactivated due to inactivity. If your Medicare Pa... Read more
Update Medicare Provider Enrollment to Avoid PTAN and NPI Issues
Critical: Ensure your PTAN hasn't been deactivated due to inactivity. If your Medicare Pa... Read more
Reader Questions:
Allow Clinicians to Make the Decision on Acute vs. Chronic
Question: I have heard varying opinions on what the exact duration of a chronic condition ... Read more
Allow Clinicians to Make the Decision on Acute vs. Chronic
Question: I have heard varying opinions on what the exact duration of a chronic condition ... Read more
Reader Questions:
Keep on Top of HIPAA Breach Reporting Deadlines
Question: We uncovered a small data breach in our practice that impacted about 225 patient... Read more
Keep on Top of HIPAA Breach Reporting Deadlines
Question: We uncovered a small data breach in our practice that impacted about 225 patient... Read more
Industry Notes:
Offer Your Opinion on Your QPP 2022 Measures’ Submission Experience
If you submitted Quality Payment Program data for the 2022 performance year, Medicare want... Read more
Offer Your Opinion on Your QPP 2022 Measures’ Submission Experience
If you submitted Quality Payment Program data for the 2022 performance year, Medicare want... Read more
Industry Notes:
Medically Unnecessary Surgeries Bring Major Penalties
Not only is performing medically inappropriate surgery on your patients morally wrong, it... Read more
Medically Unnecessary Surgeries Bring Major Penalties
Not only is performing medically inappropriate surgery on your patients morally wrong, it... Read more
HIPAA:
Say Goodbye to These 4 Enforcement Discretions
But: OCR offers one olive branch. With the COVID public health emergency (PHE) coming to... Read more
Say Goodbye to These 4 Enforcement Discretions
But: OCR offers one olive branch. With the COVID public health emergency (PHE) coming to... Read more
Medicare Quiz:
Measure Your Acronym Prowess With This Quiz
Are HCPCS, HIPAA, and HIPPS the same? Find out. The feds continue to up their acronym ga... Read more
Measure Your Acronym Prowess With This Quiz
Are HCPCS, HIPAA, and HIPPS the same? Find out. The feds continue to up their acronym ga... Read more
Part B Coding Coach:
OB-GYN: Pocket This Primer on Preventive Services
Find out how to use Medicare's ‘carve out' rule. If providing preventive ob-gyn care fo... Read more
OB-GYN: Pocket This Primer on Preventive Services
Find out how to use Medicare's ‘carve out' rule. If providing preventive ob-gyn care fo... Read more
Medicare Quiz Answers:
Check Your Responses for Our Medicare Acronym Quiz
Time to find out if you're an acronym expert. Once you've answered the questions on page... Read more
Check Your Responses for Our Medicare Acronym Quiz
Time to find out if you're an acronym expert. Once you've answered the questions on page... Read more
Industry Notes:
Feds Introduce No Upcode Act to Combat MA Issues
As Medicare Advantage plans continue to come under the microscope, it shouldn't come as a ... Read more
Feds Introduce No Upcode Act to Combat MA Issues
As Medicare Advantage plans continue to come under the microscope, it shouldn't come as a ... Read more
Industry Notes:
Add This CERT Contractor Change to Your Update List
The Comprehensive Error Rate Testing (CERT) review contractor has a new name — and new c... Read more
Add This CERT Contractor Change to Your Update List
The Comprehensive Error Rate Testing (CERT) review contractor has a new name — and new c... Read more
Industry Notes:
OIG Aims to Modernize Provider Data Collection — and Oversight
If you care about how the feds can disseminate your data, you might want to tune in to an ... Read more
OIG Aims to Modernize Provider Data Collection — and Oversight
If you care about how the feds can disseminate your data, you might want to tune in to an ... Read more
Reader Questions:
Get the Facts on Billing Medicare for Smoking/Tobacco Cessation Counseling
Question: We have a few patients with peripheral neuropathy and are trying to impleme... Read more
Get the Facts on Billing Medicare for Smoking/Tobacco Cessation Counseling
Question: We have a few patients with peripheral neuropathy and are trying to impleme... Read more
Reader Questions:
Help Patients Understand EOBs With These Tips
Question: Our Medicare beneficiaries often mistake the explanation of benefits (EOB) ... Read more
Help Patients Understand EOBs With These Tips
Question: Our Medicare beneficiaries often mistake the explanation of benefits (EOB) ... Read more
Reimbursement:
MedPAC Advocates to Bump Up Physician Pay in 2024
Industry orgs argue it's not enough. Pandemic fallout combined with rampant inflation hav... Read more
MedPAC Advocates to Bump Up Physician Pay in 2024
Industry orgs argue it's not enough. Pandemic fallout combined with rampant inflation hav... Read more
Part B Coding Coach:
Boost Transfusion Coding Prowess With These 4 Tips
Review HCPCS Level II blood product codes for differentiation. Transfusions play a key r... Read more
Boost Transfusion Coding Prowess With These 4 Tips
Review HCPCS Level II blood product codes for differentiation. Transfusions play a key r... Read more
Civil Rights:
Ensure Accommodations Are in Place for Deaf Patients
A recent settlement highlights provider's failure to help patient. If you don't have pol... Read more
Ensure Accommodations Are in Place for Deaf Patients
A recent settlement highlights provider's failure to help patient. If you don't have pol... Read more
Industry Notes:
CMS Offers Latest IDR Update on No Surprises Act
Since its enactment in 2021, the No Surprises Act has come up against a plethora of legal ... Read more
CMS Offers Latest IDR Update on No Surprises Act
Since its enactment in 2021, the No Surprises Act has come up against a plethora of legal ... Read more
Industry Notes:
Offer Your 2 Cents on MIPS Measures for PY 2025
If you want to have a say on future Merit-Based Incentive Payment System (MIPS) m... Read more
Offer Your 2 Cents on MIPS Measures for PY 2025
If you want to have a say on future Merit-Based Incentive Payment System (MIPS) m... Read more
Reader Question:
Don’t Forget About Consent for Telehealth
Question: When doing a telehealth encounter, do you need to ask for telehealth-speci... Read more
Don’t Forget About Consent for Telehealth
Question: When doing a telehealth encounter, do you need to ask for telehealth-speci... Read more
Fraud And Abuse:
Physician Convicted of COVID Accelerated and Advance Payment Fraud
Understand CMS' rules on CAAP usage, reporting, and recoupment. As the COVID-19 public he... Read more
Physician Convicted of COVID Accelerated and Advance Payment Fraud
Understand CMS' rules on CAAP usage, reporting, and recoupment. As the COVID-19 public he... Read more
Audits:
Use This Advice to Better Explain Audit Results to Providers
Tip: Include practice management in the discussion if necessary. Whether you've performe... Read more
Use This Advice to Better Explain Audit Results to Providers
Tip: Include practice management in the discussion if necessary. Whether you've performe... Read more
Part B Coding Coach:
Know the Facts on Modifier 50
Warning: Payer policies may differ, so review the fine print. There are a plethora of cod... Read more
Know the Facts on Modifier 50
Warning: Payer policies may differ, so review the fine print. There are a plethora of cod... Read more
Industry Notes:
Prepare to Stop Using CR Modifier and DR Code Starting May 12
If your coding staff are used to adding the CR modifier and the DR code to claims associat... Read more
Prepare to Stop Using CR Modifier and DR Code Starting May 12
If your coding staff are used to adding the CR modifier and the DR code to claims associat... Read more
Industry Notes:
Feds Continue to Scrutinize MA Plans
Medicare Advantage plans have been the subject of both policy updates and scrutiny over t... Read more
Feds Continue to Scrutinize MA Plans
Medicare Advantage plans have been the subject of both policy updates and scrutiny over t... Read more
Review 4 Other COVID-Related Compliance Items to Know
If you're a Medicare provider, chances are you received COVID relief money or took advanta... Read more
If you're a Medicare provider, chances are you received COVID relief money or took advanta... Read more
Reader Question:
Pocket These Fundamentals on MIPS ‘Special Status’
Question: In the last issue, you mentioned “special status” and how it impacts Me... Read more
Pocket These Fundamentals on MIPS ‘Special Status’
Question: In the last issue, you mentioned “special status” and how it impacts Me... Read more
Compliance:
Don’t Shirk on HIPAA Security Rule Requirements
Recent case shows that cybersecurity fails may lead to major penalties. As data security... Read more
Don’t Shirk on HIPAA Security Rule Requirements
Recent case shows that cybersecurity fails may lead to major penalties. As data security... Read more
HIPAA:
Bolster HIPAA Risk Analysis With These Expert Tips
Use the collected information to better safeguard patients and your organization. Thoug... Read more
Bolster HIPAA Risk Analysis With These Expert Tips
Use the collected information to better safeguard patients and your organization. Thoug... Read more
Part B Coding Coach:
Bolster Critical Care Coding With This Primer
Tip: Understand how the CY 2023 MPFS factors into the equation. If you're still sifting... Read more
Bolster Critical Care Coding With This Primer
Tip: Understand how the CY 2023 MPFS factors into the equation. If you're still sifting... Read more
MIPS Value Pathways:
Know These 7 Facts on MVP Participation
Tip: Transition to MVPs sooner rather than later, CMS advises. If you meet the low-volu... Read more
Know These 7 Facts on MVP Participation
Tip: Transition to MVPs sooner rather than later, CMS advises. If you meet the low-volu... Read more
Reader Question:
Understand These Billing Rules for Medicare-Covered Services
Question: Can a practice send a Medicare beneficiary an advanced notice of noncoverag... Read more
Understand These Billing Rules for Medicare-Covered Services
Question: Can a practice send a Medicare beneficiary an advanced notice of noncoverag... Read more
Industry Notes:
Get Ready for the PECOS Revamp
If you find Medicare's current provider enrollment process to be complicated and confusing... Read more
Get Ready for the PECOS Revamp
If you find Medicare's current provider enrollment process to be complicated and confusing... Read more
Industry Notes:
CMS Updates COVID-19 PHE Fact Sheets
As promised, CMS is changing and adding information to its COVID-19 public health emergenc... Read more
CMS Updates COVID-19 PHE Fact Sheets
As promised, CMS is changing and adding information to its COVID-19 public health emergenc... Read more
COVID-19 Update:
Feds Pencil in May 11 for COVID PHE End Date
Start planning now to avoid post-PHE pandemonium. The COVID-19 public health emergenc... Read more
Feds Pencil in May 11 for COVID PHE End Date
Start planning now to avoid post-PHE pandemonium. The COVID-19 public health emergenc... Read more
Regulations:
Bolster Your Post-COVID Policies With This Federal Insight
Stay tuned: Watch out for more changes as policies are assessed. Over the last couple of... Read more
Bolster Your Post-COVID Policies With This Federal Insight
Stay tuned: Watch out for more changes as policies are assessed. Over the last couple of... Read more
Compliance:
Foil Post-PHE Folly With These 7 Tips
Tip: Ensure staff are aware of upcoming changes and re-train accordingly as new policies ... Read more
Foil Post-PHE Folly With These 7 Tips
Tip: Ensure staff are aware of upcoming changes and re-train accordingly as new policies ... Read more
Reimbursement:
CMS Announces Update on 2024 MA and Part D Payment Policies
Deadline: Submit your comments on the advance notice before March 3. CMS expects a signif... Read more
CMS Announces Update on 2024 MA and Part D Payment Policies
Deadline: Submit your comments on the advance notice before March 3. CMS expects a signif... Read more
Reader Question:
Know These Important Facts on Reopenings
Question: Our team is trying to create an appeals policy and we're looking for ... Read more
Know These Important Facts on Reopenings
Question: Our team is trying to create an appeals policy and we're looking for ... Read more
Industry Notes:
MACs Beef Up Provider Authentication Requirements
If you need information from your Medicare Administrative Contractor (MAC) about your clai... Read more
MACs Beef Up Provider Authentication Requirements
If you need information from your Medicare Administrative Contractor (MAC) about your clai... Read more
Industry Notes:
Don’t Forget to Visit the QPP Resource Library
If you're not checking for updates to the Quality Payment Program (QPP) resource library, ... Read more
Don’t Forget to Visit the QPP Resource Library
If you're not checking for updates to the Quality Payment Program (QPP) resource library, ... Read more
Industry Notes:
Ensure Your Staff Are Legally Credentialed
Not only do you need to check the HHS Office of Inspector General (OIG's) searchable datab... Read more
Ensure Your Staff Are Legally Credentialed
Not only do you need to check the HHS Office of Inspector General (OIG's) searchable datab... Read more
Medicare Advantage:
Equity Factors Heavily in 2024 MA Proposals
Access, transparency, and communication play key roles in policymaking. COVID revealed a... Read more
Equity Factors Heavily in 2024 MA Proposals
Access, transparency, and communication play key roles in policymaking. COVID revealed a... Read more
Fraud & Abuse:
Feds Kick Off 2023 With Enforcement Shockers
January actions include charges for embezzlement, racketeering, and more. Even though w... Read more
Feds Kick Off 2023 With Enforcement Shockers
January actions include charges for embezzlement, racketeering, and more. Even though w... Read more
Part B Coding Coach:
ICD-10 2023: Manage SDoH Updates With These FAQs
Look to the guidelines for all the info you need. On Oct. 1, more than 1,700 ICD-10-CM co... Read more
ICD-10 2023: Manage SDoH Updates With These FAQs
Look to the guidelines for all the info you need. On Oct. 1, more than 1,700 ICD-10-CM co... Read more
Clip And Save:
Get a Grip on Calculating ‘Days in A/R’ With These FAQs
Tip: Explain the A/R timeline to providers, too. Even if you've stayed on top of the annu... Read more
Get a Grip on Calculating ‘Days in A/R’ With These FAQs
Tip: Explain the A/R timeline to providers, too. Even if you've stayed on top of the annu... Read more
Industry Notes:
Offer Your Opinion on the Medicare Overpayment Proposed Rules ASAP
If you missed Medicare's proposed rule on overpayment procedures, there's still time to ca... Read more
Offer Your Opinion on the Medicare Overpayment Proposed Rules ASAP
If you missed Medicare's proposed rule on overpayment procedures, there's still time to ca... Read more
Industry Notes:
Expect Your Practice Telehealth Offerings to Show Up on Care Compare
If you utilize telehealth services and provide care for your patients via the popular tech... Read more
Expect Your Practice Telehealth Offerings to Show Up on Care Compare
If you utilize telehealth services and provide care for your patients via the popular tech... Read more
Industry Notes:
Weigh in on 2024 MVP Candidates By Feb. 8
If you want to weigh in on possible candidates for the 2024 Merit-Based Incentive Payment ... Read more
Weigh in on 2024 MVP Candidates By Feb. 8
If you want to weigh in on possible candidates for the 2024 Merit-Based Incentive Payment ... Read more
COVID-19 Round-Up:
Bolster Your COVID Policies With These 5 Updates
Prepare now for the end of the PHE, experts warn. With other issues dominating the feder... Read more
Bolster Your COVID Policies With These 5 Updates
Prepare now for the end of the PHE, experts warn. With other issues dominating the feder... Read more
OIG Reports Big Jump in Part B Lab Spending
HCPCS code may have been a factor in the increase. With COVID hitting the U.S. hard over ... Read more
HCPCS code may have been a factor in the increase. With COVID hitting the U.S. hard over ... Read more
HIPAA:
OCR Kicks New Year Off With Right of Access Settlement
Adapt policies now to ensure employees know the rules. Due to the pandemic, HIPAA enforce... Read more
OCR Kicks New Year Off With Right of Access Settlement
Adapt policies now to ensure employees know the rules. Due to the pandemic, HIPAA enforce... Read more
Part B Coding Coach:
Know the Facts on the New Chronic Pain Management Code
And find out the reimbursement amounts for the new code and add-on code. Chronic pain m... Read more
Know the Facts on the New Chronic Pain Management Code
And find out the reimbursement amounts for the new code and add-on code. Chronic pain m... Read more
Industry Notes:
Keep on Top of TPE Active and Pending Lists
When the Medicare Administrative Contractors (MACs) slowly restarted Targeted Probe and Ed... Read more
Keep on Top of TPE Active and Pending Lists
When the Medicare Administrative Contractors (MACs) slowly restarted Targeted Probe and Ed... Read more
Industry Notes:
Submit Your Quarterly Medicare Credit Balance Report by Jan. 30
Don't delay sending Medicare your credit balance report for the quarter that ended on Dec.... Read more
Submit Your Quarterly Medicare Credit Balance Report by Jan. 30
Don't delay sending Medicare your credit balance report for the quarter that ended on Dec.... Read more
Budget:
Congress Offers a 2023 Conversion Factor Olive Branch
Plus: Feds opt to extend some telehealth flexibilities … again. If you thought the feds... Read more
Congress Offers a 2023 Conversion Factor Olive Branch
Plus: Feds opt to extend some telehealth flexibilities … again. If you thought the feds... Read more
Compliance:
Documentation Issues Continue to Plague Medicare Providers
But, there were some outliers this year among the claims groups. If your Medicare claims ... Read more
Documentation Issues Continue to Plague Medicare Providers
But, there were some outliers this year among the claims groups. If your Medicare claims ... Read more
Part B Coding Coach:
ED Coding: Add This Tetanus Shot Primer to Your Toolkit
Critical: Calculate how a tetanus shot factors into MDM risk. When coding an evaluation a... Read more
ED Coding: Add This Tetanus Shot Primer to Your Toolkit
Critical: Calculate how a tetanus shot factors into MDM risk. When coding an evaluation a... Read more
Reader Question:
Know the Facts on Medicare Coverage for These Exams
Question: What's the difference between an annual well visit and a well-woman visit? ... Read more
Know the Facts on Medicare Coverage for These Exams
Question: What's the difference between an annual well visit and a well-woman visit? ... Read more
Industry Note:
Even Medicare Contractors Are at Risk of a Data Breach
Healthcare providers aren't the only ones menaced by HIPAA breaches and their fallout. Me... Read more
Even Medicare Contractors Are at Risk of a Data Breach
Healthcare providers aren't the only ones menaced by HIPAA breaches and their fallout. Me... Read more
Industry Note:
CMS Offers MIPS EUC Application Extension — With Restrictions
If your practice was impacted by COVID-19 and you were planning on submitting a Merit-Base... Read more
CMS Offers MIPS EUC Application Extension — With Restrictions
If your practice was impacted by COVID-19 and you were planning on submitting a Merit-Base... Read more
Industry Note:
Sign Up With CMS for January Listening Session on E-Signature Rules
If you've got opinions about electronic signature requirements, Medicare officials want to... Read more
Sign Up With CMS for January Listening Session on E-Signature Rules
If you've got opinions about electronic signature requirements, Medicare officials want to... Read more