Healthcare Business Monthly
Compliance Program Guidance Released
New compliance program guidance has been issued by the Fraud Section of the Department of Justice (DOJ), according to an article published in the AHLA Weekly. Although the "Evaluation of Corporate Compliance Programs" (Guidance) is not specific to the healthcare industry, it does provide a practical set of benchmarks against which the audit & compliance committee, in consultation with the general counsel and the chief compliance officer, can evaluate the effectiveness of the health system's compliance program.
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CMS Now Covers 99358, +99359 Prolonged Services
The Centers for Medicare & Medicaid Services (CMS) typically does not allow separate payment for physician services that do not require face-to-face time with a patient. As of Jan. 1, 2017, CMS has made an exception and will now allow Medicare coverage for non face-to-face prolonged service codes 99358 Prolonged evaluation and management service before and/or after direct patient care; first hour and +99359 …each additional 30 minutes (List separately in addition to code for prolonged service), in compliance with CPT® guidelines.
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Medicare Will Pay for Flu Vaccine 90682
It's been a rough 2016-2017 influenza season, to be sure, and it's not over, yet. The CDC recommends clinicians continue vaccination efforts as long as flu viruses are circulating.
As of Feb. 3, approximately 145 million doses of influenza vaccine had been distributed in the United States — enough to vaccinate nearly half of the U.S. population.
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Stick with G Codes for Medicare Mammography
The 2017 CPT® codebook introduced three new codes to describe mammography services;
•  77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
•  77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral

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Free Resources for Eligible Clinicians
Get the help you need to succeed in the Quality Payment Program.
There are many free resources available to help eligible clinicians successfully participate in the Quality Payment Program (QPP). Through the established Quality Innovation Networks, the Transforming Clinical Practice Initiatives, and the Alternative Payment Model Learning Systems, every clinician in the Quality Payment Program can receive in-person training, including information about the Merit-based Incentive Payment System, as well as the Alternative Payment Model (APM) track.
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Medicare Launches Quality-based Pay Models for Tracking Heart, Ortho Care
Small practices and facilities stand to benefit from new payment models based on new quality measures for coronary and orthopedic care.
In December, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models shifting Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost.
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