Corporate Compliance

Corporate Compliance Articles by Topic: Medicare Coverage and Reimbursement

Medicare Audit Improvement Act reintroduced, AHIMA shows support

  • Medicare Insider, Issue 12, March 26, 2013

    The Medicare Audit Improvement Act, which aims to rectify problems identified in the Recovery...

The week in Medicare updates

  • Medicare Insider, Issue 12, March 26, 2013

    Highlights of the past week’s Medicare updates include the accompanying transmittal for the...

Note from the instructor: Details released on Part A to B rebilling ruling

  • Medicare Insider, Issue 12, March 26, 2013

    Most of you reading this likely already know that CMS released a ruling on March 13 that revises...

Recent Recovery Auditor Activity

  • Medicare Insider, Issue 11, March 19, 2013

    Performant Recovery posted four new issues across three categories, Connolly posted a new issue for...

Important Medicare Updates

  • Medicare Insider, Issue 11, March 19, 2013

    This past week’s updates includes the notice of ruling and proposed rule on Part B billing in...

CMS issues proposed changes to Part B inpatient billing in hospitals

  • Medicare Insider, Issue 11, March 19, 2013

    Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed...

Other issuances: CMS issues press release on prescription drug cost savings, fact sheet on building exchanges, and more

  • Medicare Insider, Issue 49, December 4, 2012

    CMS issues press release on prescription drug cost savings

Transmittals and MLN Matters articles: CMS issues therapy cap values for CY 2013, instructs on claims-based data colelction for outpatient therapy services, and more

  • Medicare Insider, Issue 49, December 4, 2012

    CMS issues therapy cap values for CY 2013

Regulations: CMS issues draft notice of Benefit and Payment Parameters for 2014

  • Medicare Insider, Issue 49, December 4, 2012

    CMS issues draft notice of Benefit and Payment Parameters for 2014

CMS releases the details for the outpatient therapy claims-based data collection requirement

  • Medicare Insider, Issue 49, December 4, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Other issuances: OIG issues a number of reviews and CMS issues fact sheet and press releases

  • Medicare Insider, Issue 48, November 27, 2012

    CMS issues notice on hospital outpatient payment panel

Regulations: CMS posts two final rules in Federal Register

  • Medicare Insider, Issue 47, November 20, 2012

    CMS issues 2013 OPPS final rule in Federal Register

Note from the instructor: OIG weighs in on ALJ appeals

  • Medicare Insider, Issue 47, November 20, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Transmittals and MLN Matters articles: CMS issues transmittal on testing HIPAA transactions following a system change, updates chapter 41 of the Provider Reimbursement Manual, and more

  • Medicare Insider, Issue 47, November 20, 2012

    CMS issues transmittal on testing HIPAA transactions following a system change

Other issuances: OIG issues reviews of Medicare appeals at the Administrative Law Judge level in 2010 and payments to skilled nursing facilities in 2009

  • Medicare Insider, Issue 47, November 20, 2012

    Other issuances: OIG issues reviews of Medicare appeals at the administrative law judge level in...

Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

  • Medicare Insider, Issue 46, November 13, 2012

    Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

Other issuances: OIG issues reviews of outpatient billing for selected drugs in Calif. And more

  • Medicare Insider, Issue 46, November 13, 2012

    CMS issues technology assessment on electronic cardiac devices

Other issuances: CMS issues letters on a nursing home clarification and the ESRD core survey process, and more

  • Medicare Insider, Issue 45, November 6, 2012

    CMS issues nursing home clarification letter

Transmittals and MLN Matters articles: CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs and much more

  • Medicare Insider, Issue 45, November 6, 2012

    CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs

Regulations: CMS issued the following final rule: 2013 OPPS, Physician Fee Schedule, Home Health PPS, and End Stage Renal Disease PPS

  • Medicare Insider, Issue 45, November 6, 2012

    CMS issues 2013 OPPS final rule

Note from the instructor: CMS publishes the 2013 OPPS and MPFS final rules

  • Medicare Insider, Issue 45, November 6, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Regulations: CMS issues corrections to two final rules

  • Medicare Insider, Issue 44, October 30, 2012

    CMS issues corrections to 2013 IPPS final rule

Note from the instructor: Clarification regarding $716 billion in cost savings to Medicare Program under the Affordable Care Act

  • Medicare Insider, Issue 44, October 30, 2012

    Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

Other issuances: CMS issues press release on 2013 quality ratings for Medicare health and drug plans and more

  • Medicare Insider, Issue 43, October 23, 2012

    CMS issues details on evidentiary characteristics for CED MEDCAC meeting

Transmittals and MLN Matters articles: CMS updates two manuals and more

  • Medicare Insider, Issue 43, October 23, 2012

    CMS updates chapter 7, Medicare Financial Management Manual

Regulations: CMS issues correcting amendment to 2013 IPPS final rule

  • Medicare Insider, Issue 43, October 23, 2012

    CMS issues correcting amendment to 2013 IPPS final rule

CMS issues next wave of supervision decisions on Hospital Outpatient Payment Panel

  • Medicare Update for CAHs, Issue 21, October 17, 2012

    Earlier this year, CMS held its first Hospital Outpatient Payment Panel meeting, which managed to...

Other issuances: CMS issues press release on 2013 quality ratings for Medicare health and drug plans and more

  • Medicare Insider, Issue 42, October 16, 2012

    CMS issues press release on 2013 quality ratings for Medicare health and drug plans

Transmittals and MLN Matters articles: CMS issues notice of new interest rate for Medicare overpayments and underpayments and more

  • Medicare Insider, Issue 42, October 16, 2012

    CMS issues notice of new interest rate for Medicare overpayments and underpayments

Note from the instructor: Correction to the FY2013 IPPS Final Rule

  • Medicare Insider, Issue 42, October 16, 2012

    Editor’s note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is...

Regulations: CMS issues corrections to two final rules

  • Medicare Insider, Issue 41, October 9, 2012

    CMS issues corrections to administrative simplification final rule

Note from the instructor: Hospital Outpatient Payment Panel announces recommendations

  • Medicare Insider, Issue 41, October 9, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Transmittals and MLN Matters articles: CMS issues new waived tests, annual clotting factor furnishing fee update 2013, and more

  • Medicare Insider, Issue 41, October 9, 2012

    CMS issues new waived tests

Note from the instructor: Implementation of FY 2013 Value-Based Purchasing Program (VBPP) and Hospital Readmission Reduction Program (HRRP) adjustments to IPPS hospital operating payments has begun

  • Medicare Insider, Issue 40, October 2, 2012

    Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

Transmittals and MLN Matters articles: CMS replaces transmittal on manual medical review of therapy services and more

  • Medicare Insider, Issue 40, October 2, 2012

    CMS replaces transmittal on manual medical review of therapy services

Other issuances: CMS issues preliminary decisions on recommendations of outpatient payment panel on supervision levels for select services and more

  • Medicare Insider, Issue 40, October 2, 2012

    Other issuances: CMS issues preliminary decisions on recommendations of outpatient payment panel on...

Note from the instructor: CMS policies and conversion from ICD-9 to ICD-10

  • Medicare Insider, Issue 39, September 25, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Transmittals and MLN Matters articles: CMS issues transmittal on ICD-10 conversions from ICD-9 and more

  • Medicare Insider, Issue 39, September 25, 2012

    CMS issues transmittal on ICD-10 conversions from ICD-9  

Other issuances: CMS issues press release on Medicare Advantage and Affordable Care Act

  • Medicare Insider, Issue 39, September 25, 2012

    CMS issues press release on Medicare Advantage

Note from the instructor: National provider call on implementation of Value-based Purchasing Program to be held in October

  • Medicare Insider, Issue 38, September 18, 2012

    Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

Transmittals and MLN Matters articles: CMS issues training series for nursing homes and more

  • Medicare Insider, Issue 38, September 18, 2012

    CMS issues training series for nursing homes  

Other issuances: OIG issues review of inpatient rehabilitation facility claims with late patient assessment instruments and more

  • Medicare Insider, Issue 38, September 18, 2012

    OIG issues review of inpatient rehabilitation facility claims with late patient assessment...

Other issuances: CMS issues revised manual instructions for the ABN and more

  • Medicare Insider, Issue 37, September 11, 2012

    CMS issues technology assessment on ECG-based analysis technologies

Transmittals and MLN Matters articles: CMS issues transmittal on expiration of 2012 therapy cap revisions and user-controlled mechanism to identify legislative effective dates and more

  • Medicare Insider, Issue 37, September 11, 2012

    CMS issues transmittal on expiration of 2012 therapy cap revisions and user-controlled mechanism to...

Regulations: CMS issues administrative simplification final rule and EHR incentive program final rule

  • Medicare Insider, Issue 37, September 11, 2012

    CMS issues administrative simplification final rule

Note from the instructor: Outpatient therapy manual medical reviews begin October 1 for hospitals

  • Medicare Insider, Issue 37, September 11, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Note from the instructor: Corrections to OPPS payment rates and OPPS and IPPS wage indices

  • Medicare Insider, Issue 34, August 21, 2012

    Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

Transmittals and MLN Matters articles: CMS updates IPF PPS and IRF PPS pricer changes for FY 2013

  • Medicare Insider, Issue 34, August 21, 2012

    CMS updates inpatient psychiatric facilities PPS for FY 2013

Other issuances: OIG issues report on leuprolide acetate injections in Ohio and more

  • Medicare Insider, Issue 34, August 21, 2012

    OIG issues report on leuprolide acetate injections in Ohio

CMS Public Events: Recovery Auditor prepayment review ODF transcript and audio

  • Medicare Insider, Issue 34, August 21, 2012

    The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...

Other issuances: CMS issues NCDs and OIG issues inappropriate billing reports

  • Medicare Insider, Issue 33, August 14, 2012

    CMS issues NCD for TAVR (20.32)

Regulations: CMS issues interim final rule for healthcare EFT and RA transactions

  • Medicare Insider, Issue 33, August 14, 2012

    CMS issues interim final rule for adoption of operating rules for healthcare EFT and RA transactions

Note from the instructor: Financial impacts of the Hospital Readmissions Reduction Program

  • Medicare Insider, Issue 33, August 14, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

CMS Public Events: Special Recovery Auditor prepayment review demonstration open door forum

  • Medicare Insider, Issue 32, August 7, 2012

    CMS will hold a special open door forum on the Medicare fee-for-service Recovery Auditor prepayment...

Other issuances: OIG issues Medicare compliance review of Boston hospital and more

  • Medicare Insider, Issue 32, August 7, 2012

    CMS issues an NCA for autologous blood-derived products for chronic non-healing wounds (CAG-00190R3)

Transmittals and MLN Matters articles: CMS issues directions to modify institutional reason code 39012

  • Medicare Insider, Issue 32, August 7, 2012

    CMS issues directions to modify institutional reason code 39012

Regulations: CMS releases 2013 IPPS final rule

  • Medicare Insider, Issue 32, August 7, 2012

    On August 1, CMS issued a display copy of the 2013 inpatient prospective payment system final rule.

Note from the instructor: CMS issues FY2013 IPPS Final Rule

  • Medicare Insider, Issue 32, August 7, 2012

    Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

Other issuances: Obama administration announces public-private partnership to prevent healthcare fraud and CMS issues an NCA

  • Medicare Insider, Issue 31, July 31, 2012

    Obama administration announces public-private partnership to prevent healthcare fraud

Transmittals and MLN Matters articles: CMS issues new waived tests

  • Medicare Insider, Issue 31, July 31, 2012

    CMS issues new waived tests

Regulations: CMS issues two proposed rules in the Federal Register

  • Medicare Insider, Issue 31, July 31, 2012

    CMS issues 2013 OPPS proposed rule  

Note from the instructor: CMS posts questions and answers on three-day window

  • Medicare Insider, Issue 31, July 31, 2012

    Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

Other issuances: CMS issues three-day payment window FAQs, 2012 Nursing Home Action Plan, and more

  • Medicare Insider, Issue 28, July 10, 2012

    CMS issues three-day payment window FAQs

Transmittals and MLN Matters articles: CMS replaces transmittal on reporting of recoupment for overpayment on the RA

  • Medicare Insider, Issue 28, July 10, 2012

    CMS replaces transmittal on reporting of recoupment for overpayment on the RA

Regulations: CMS issues 2013 OPPS proposed rule, 2013 physician fee schedule proposed rule, and more

  • Medicare Insider, Issue 28, July 10, 2012

    CMS issues 2013 OPPS proposed rule

Note from the instructor: CMS announces CY 2013 OPPS proposed rule

  • Medicare Insider, Issue 28, July 10, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Note from the instructor: Revised Mental Health Services Booklet (ICN 903195) available through Medicare Learning Network

  • Medicare Insider, Issue 27, July 3, 2012

    Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

Transmittals and MLN Matters articles: CMS updates Medicare Managed Care Manual and more

  • Medicare Insider, Issue 27, July 3, 2012

    CMS replaces transmittal on October quarterly update HCPCS codes used for SNF CB enforcement  

Other issuances: CMS issues press release on healthcare law and more

  • Medicare Insider, Issue 27, July 3, 2012

    CMS issues press release on healthcare law

Note from the instructor: Changes to device edits for July 2012

  • Medicare Insider, Issue 26, June 26, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Transmittals and MLN Matters articles: CMS instructs on provider self audits

  • Medicare Insider, Issue 26, June 26, 2012

    CMS issues transmittal on provider self audits

Other issuances: OIG issues Medicare compliance reviews and more

  • Medicare Insider, Issue 26, June 26, 2012

    CMS issues an NCA for liver transplantation for malignancies

Regulations: CMS issues Medicare secondary payer and future medicals proposed rule and more

  • Medicare Insider, Issue 25, June 19, 2012

    CMS posts IPPS proposed and final rules, relevant correction notices for FY 2013

Transmittals and MLN Matters articles: CMS issues transmittal on process for handling esMD and more

  • Medicare Insider, Issue 25, June 19, 2012

    CMS issues transmittal on process for handling esMD

Other issuances: CMS issues July 2012 NCD Coding Policy Manual and Change Report and more

  • Medicare Insider, Issue 25, June 19, 2012

    CMS issues July 2012 NCD Coding Policy Manual and Change Report

Note from the instructor: July 2012 quarterly update contains multiple significant updates and clarifications

  • Medicare Insider, Issue 24, June 12, 2012

    Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

Note from Peggy: NPI vs. PTAN

  • Medicare Update for Physician Services, Issue 6, June 7, 2012

    Were you ever curious about the difference between the National Provider Identifier (NPI) versus...

Note from the instructor: CMS announces supervision levels for select services

  • Medicare Insider, Issue 23, June 5, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Note from the instructor: CMS to release new short-term acute care PEPPER

  • Medicare Insider, Issue 22, May 29, 2012

    Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

Transmittals and MLN Matters articles: CMS replaces transmittal on screening for STIs and HIBC to prevent STIs (ICD-10) and more

  • Medicare Insider, Issue 22, May 29, 2012

    CMS replaces transmittal on screening for STIs and HIBC to prevent STIs (ICD-10)

Other issuances: CMS instructs on use of insulin pens in healthcare facilities and more.

  • Medicare Insider, Issue 22, May 29, 2012

    CMS instructs on use of insulin pens in healthcare facilities

Transmittals and MLN Matters articles: CMS updates the enrollment manual and more

  • Medicare Insider, Issue 21, May 22, 2012

    CMS issues general update to chapter 15 of the PIM – Part VI

Regulations: CMS posts rules to cut regulations for hospitals and providers

  • Medicare Insider, Issue 21, May 22, 2012

    CMS posts rules to cut regulations for hospitals and providers

Other issuances: OIG issues Medicare compliance reviews and CMS issues an NCA for autologous blood-derived products for chronic non-healing wounds

  • Medicare Insider, Issue 20, May 15, 2012

    OIG issues compliance re view of Missouri hospital

Transmittals and MLN Matters articles: CMS instructs on implementation of fraud prevention predictive modeling prepayment edits and more

  • Medicare Insider, Issue 20, May 15, 2012

    CMS instructs on implementation of fraud prevention predictive modeling prepayment edits and more

Regulations: CMS releases 2013 IPPS proposed rule, finalizes rules to cut regulations for hospitals and providers, saving more than $5 billion

  • Medicare Insider, Issue 20, May 15, 2012

    CMS releases 2013 IPPS proposed rule, finalizes rules to cut regulations for hospitals and...

Note from the instructor: New CoP addresses patient self-administration of medications

  • Medicare Insider, Issue 20, May 15, 2012

    Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

Other issuances: OIG issues review of outpatient brachytherapy payments in Florida and more

  • Medicare Insider, Issue 19, May 8, 2012

    On May 3, the OIG issued a review of outpatient brachytherapy Medicare payments at Lakewood Rance...

Transmittals and MLN Matters articles: CMS issues transmittal containing revisions of the financial limitation for outpatient therapy services and more

  • Medicare Insider, Issue 19, May 8, 2012

    On April 27, CMS issued a transmittal that extends the therapy cap exceptions process through...

Regulations: CMS issues Medicaid community first choice option final rule and Medicaid state plan home and community-based services proposed rule

  • Medicare Insider, Issue 19, May 8, 2012

    On May 7, CMS issued in the Federal Register a final rule that implements section 2401 of the...

Note from the Instructor: CMS issues further guidance on outpatient therapy caps and the related exceptions process

  • Medicare Insider, Issue 19, May 8, 2012

    In a recent transmittal, CMS issued guidance on Congress’ extension of limitations on certain...

Regulations: CMS proposes one-year delay of ICD-10-CM/PCS, issues final rule on provider and supplier enrollment, ordering and referring, and documentation requirements, issues corrections to 2012 OPPS rule, and more

  • Medicare Update for Physician Services, Issue 5, May 3, 2012

    CMS issues final rule on provider and supplier enrollment, ordering and referring, and...

Transmittals/MLN Matters articles:

  • Medicare Update for Physician Services, Issue 5, May 3, 2012

    CMS revises "incident to" transmittal

Quarterly updates: CMS updates Part B drug pricing files

  • Medicare Update for Physician Services, Issue 5, May 3, 2012

    CMS updates Part B drug pricing files

Other developments: OIG issues review of Medicare outpatient billing for selected drugs at Catskill Regional Medical Center, issues report on claim modifier ?KX, and more

  • Medicare Update for Physician Services, Issue 5, May 3, 2012

    OIG issues review of Medicare outpatient billing for selected drugs at Catskill Regional Medical...

Other issuances: OIG issues billing compliance reports, CMS issues guidance on determination rural location, and more

  • Medicare Insider, Issue 18, May 1, 2012

    OIG issues report on Southern Calif. Renal Disease Council inc. billing compliance

Transmittals and MLN Matters articles: CMS issues guidance on overpayment recovery from DMEPOS suppliers and updates part 1, chapter 9 of the Provider Reimbursement Manual

  • Medicare Insider, Issue 18, May 1, 2012

    CMS issues guidance on overpayment recovery from DMEPOS suppliers

Regulations: CMS issues IPPS proposed rule, issues 2012 OPPS corrections, and more

  • Medicare Insider, Issue 18, May 1, 2012

    CMS issues IPPS proposed rule for FY2013

Note from the Instructor: CMS releases the IPPS Proposed Rule

  • Medicare Insider, Issue 18, May 1, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Other issuances: OIG posts new compliance reviews, CMS issues press release on home health agency patient surveys, and more

  • Medicare Insider, Issue 17, April 24, 2012

    OIG issues Medicare compliance review of D.C. hospital

Transmittals and MLN Matters articles: CMS posts new MLN Matters articles

  • Medicare Insider, Issue 17, April 24, 2012

    MLN Matters articles

Regulations: HHS issues administrative simplification proposed rule, CMS issues corrections to EHR proposed rule

  • Medicare Insider, Issue 17, April 24, 2012

    HHS issues administrative simplification proposed rule

Note from the Instructor: ICD-10 Delay

  • Medicare Insider, Issue 17, April 24, 2012

    Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

Note: CMS establishes two new OPPS device categories for transitional pass-through status

  • Medicare Insider, Issue 38, September 20, 2011

    CMS provides updates on a quarterly basis during the calendar year to reflect changes to, and...

Events: August 9 Hospital Open Door Forum transcript available

  • Medicare Update for Physician Services, Issue 9, September 2, 2011

    MedicareFind subscribers can now access the written transcript and audio recording of the...

Quarterly updates: CMS posts HCPCS update, I/OCE changes, and more

  • Medicare Update for Physician Services, Issue 9, September 1, 2011

    CMS has posted its regular update transmittal for HCPCS Level II codes.

Transmittals and MLN Matters articles: CMS posts MUE instructions

  • Medicare Insider, Issue 33, August 16, 2011

    On August 12, CMS issued a transmittal to give instructions regarding the medically unlikely edits...

Transmittals/MLN Matters articles: CMS instructs on RAC demand letters, updates cardiac/pulmonary rehab edits, and more

  • Medicare Insider, Issue 32, August 9, 2011

    On July 29, CMS issued a transmittal to shift responsibility for issuance of demand letters from...

Note: FY2012 IPPS final rule posted

  • Medicare Insider, Issue 32, August 9, 2011

    The FY2012 IPPS final rule was put on display this week.   The rule contained some...

Transmittals/MLN Matters articles: CMS instructs on imaging accreditation, eRx, and more

  • Medicare Update for Physician Services, Issue 8, August 4, 2011

    CMS posted a special edition MLN Matters article to provide assistance to providers in meeting the...

Quarterly updates: CMS updates CLIA list, lab NCDs, and more

  • Medicare Update for Physician Services, Issue 8, August 4, 2011

    On July 22, CMS issued a transmittal to inform contractors of new HCPCS codes subject to the CLIA...

Regulations: CMS publishes OPPS proposals

  • Medicare Insider, Issue 30, July 26, 2011

    On July 18, CMS published in the Federal Register a proposed rule to modify the OPPS for calendar...

Transmittals and MLN Matters articles: CMS updates CLIA list, lab NCD edits

  • Medicare Insider, Issue 30, July 26, 2011

    On July 22, CMS issued a transmittal to inform contractors of new HCPCS codes subject to the CLIA...

Transmittals and MLN Matters articles: CMS issues NCD for prostate cancer treatment, updates ESRD PPS, and more

  • Medicare Insider, Issue 29, July 19, 2011

    On July 15, CMS issued a transmittal to make quarterly updates to the end-stage renal disease...

Note: OPPS proposed rule affects imaging payments

  • Medicare Insider, Issue 29, July 19, 2011

    In 2011, the AMA introduced three new CPT codes for computed tomography (CT) of the abdomen and...

Other Issuances: CMS updates lab NCDs, OPPS addenda

  • Medicare Insider, Issue 28, July 12, 2011

    CMS has posted a new version of the lab NCD manual for the third quarter.

Regulations: CMS proposes OPPS, MPFS changes

  • Medicare Insider, Issue 28, July 12, 2011

    CMS has released a display copy of a proposed rule to make changes to the OPPS for 2012.

Note: CMS announces 2012 OPPS proposed rule

  • Medicare Insider, Issue 28, July 12, 2011

    CMS released the OPPS proposed rule almost one month earlier than we usually see it.  CMS...

Note from Peggy: Routine foot care coverage summary

  • Medicare Update for Physician Services, Issue 7, July 7, 2011

    CMS released a special edition MLN Matters article regarding foot care coverage guidelines. ...

Regulations: CMS issues MPFS proposal, RVU review, and more

  • Medicare Update for Physician Services, Issue 7, July 7, 2011

    CMS has posted a display copy of the physician fee schedule proposed rule for 2012.

Quarterly updates: CMS updates waived tests and more

  • Medicare Update for Physician Services, Issue 7, July 7, 2011

    CMS has released its regular update to inform contractors of new waived tests under CLIA.

Note: Special editions highlight inpatient coding vulnerabilities and admit date issues

  • Medicare Insider, Issue 26, June 28, 2011

    CMS released two special edition MLN articles this week.  One article, SE1121, highlights some...

Transmittals and MLN Matters articles: CMS advises on documentation, notifies of new waived tests, and more

  • Medicare Insider, Issue 26, June 28, 2011

    CMS has issued a special MLN Matters article on DRG coding vulnerabilities for inpatient...

Other Issuances: CMS posts new IPPE FAQs

  • Medicare Insider, Issue 25, June 21, 2011

    CMS has posted a new set of FAQs on the initial preventive physical examination (IPPE).

Note: Provider-friendly change to tracking observation hours

  • Medicare Insider, Issue 25, June 21, 2011

    In the July OPPS update, CMS made a manual change to the section on counting observation hours that...

Note: Medicaid payments and provider-preventable conditions

  • Medicare Insider, Issue 24, June 14, 2011

    Last February, I wrote about the proposed rule for Medicaid health care-acquired conditions (HCACs...

Regulations: HHS issues HIPAA/HITECH regulations, CMS finalizes Medicaid HCAC rule

  • Medicare Insider, Issue 23, June 7, 2011

    On June 1, CMS released a rule to finalize a payment adjustment for provider-preventable...

Transmittals and MLN Matters articles: CMS updates OPPS, issues special edition coverage articles, and more

  • Medicare Insider, Issue 23, June 7, 2011

    CMS has issued its regular updates to the OPPS for July. The update includes information on new...

Note: The new frontier of coverage denials

  • Medicare Insider, Issue 23, June 7, 2011

    This week CMS released a special edition MLN Matters article reviewing the coverage of...

Events: May 17 Physician Open Door Forum transcript available

  • Medicare Update for Physician Services, Issue 6, June 2, 2011

    MedicareFind subscribers can now access a transcript and recording of the April 5 Physicians...

Quarterly updates: CMS releases updated RVU file, MPFS update, and more

  • Medicare Update for Physician Services, Issue 6, June 2, 2011

    CMS has posted the RVU quarterly update file under the MPFS.

Regulations: CMS clarifies three-day rule, posts vaccine proposal

  • Medicare Update for Physician Services, Issue 6, June 2, 2011

    As part of its recently released proposed rule for the inpatient prospective payment system, CMS...

Note: Accountable care organizations - A new way to coordinate the delivery of quality healthcare to beneficiaries enrolled in original Medicare

  • Medicare Insider, Issue 22, May 31, 2011

    In an effort to provide quality healthcare to beneficiaries enrolled in original Medicare (Medicare...

Transmittals and MLN Matters articles: CMS clarifies CRNA pass-through, updates IPF PPS, and more

  • Medicare Insider, Issue 22, May 31, 2011

    On May 20, CMS issued a transmittal to provide further clarification regarding certified...

Note: Critical access hospitals and ambulance services

  • Medicare Insider, Issue 21, May 24, 2011

    This was another light week at CMS, so I wanted to return to the FY 2012 IPPS proposed rule to talk...

Other Issuances: CMS advises on SNF consolidated billing, claims processing issues, and more

  • Medicare Insider, Issue 21, May 24, 2011

    On May 16, the OIG issued a report on CMS’ oversight and enforcement of HIPAA. The OIG...

Note: Payers misunderstand HACs and never events

  • Medicare Insider, Issue 20, May 17, 2011

    This week was a light week so I thought I would write about a trend I’ve come across related...

Transmittals and MLN Matters articles: CMS clarifies pharmacy billing, posts NCCI update instructions, and more

  • Medicare Insider, Issue 20, May 17, 2011

    On May 13, CMS issued a transmittal to clarify policy with respect to restrictions on pharmacy...

MedicareFind Forum Spotlight: Brachytherapy

  • Medicare Insider, Issue 20, May 17, 2011

    High dose brachytherapy is not listed as an inpatient procedure but requires a patient to remain...

CMS Public Events: April 27 Hospital Open Door Forum transcript available

  • Medicare Insider, Issue 19, May 10, 2011

    MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Note: CMS announces a "three-day payment window clarification" in the IPPS proposed rule

  • Medicare Insider, Issue 19, May 10, 2011

    Last week, I addressed one of the clarifications that CMS had announced in the FY 2012 IPPS...

Events: April 5 Open Door Forum transcript available

  • Medicare Update for Physician Services, Issue 5, May 5, 2011

    MedicareFind subscribers can now access a transcript of the April 5 Physicians, Nurses and Allied...

Note from Peggy: Savings on account of ACOs

  • Medicare Update for Physician Services, Issue 5, May 5, 2011

    In the April 7 edition of the Federal Register, CMS released a proposed rule concerning Medicare...

Transmittals and MLN Matters articles: CMS posts MLN Matters articles

  • Medicare Insider, Issue 18, May 3, 2011

    CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare...

Regulations: CMS finalizes value-based purchasing provisions, issues IRF PPS proposed rule, and more

  • Medicare Insider, Issue 18, May 3, 2011

    CMS has posted a display copy of a final rule to implement a value-based purchasing program under...

Three Miami-area residents headed to jail for $23 million Medicare fraud scheme

  • Compliance Monitor, Issue 17, April 27, 2011

    Two Miami-area medical assistants and a physician assistant will serve time in prison for their...

Ohio pharmaceutical company pays $8 million to resolve kickback allegations

  • Compliance Monitor, Issue 17, April 27, 2011

    Cardinal Health Inc. agreed to pay $8 million to resolve claims that it violated the False Claims...

Regulations: CMS posts IPPS proposed rule for 2012

  • Medicare Insider, Issue 17, April 26, 2011

    CMS has issued for public inspection a proposed rule to make changes to the inpatient prospective...

Owners of a mental health corporation plead guilty to $200 million fraud scheme

  • Compliance Monitor, Issue 16, April 20, 2011

    Two Miami-area residents and owners of a mental healthcare corporation pleaded guilty to submitting...

Miami doctor convicted in $23 million Medicare fraud scheme

  • Compliance Monitor, Issue 16, April 20, 2011

    A jury convicted Miami physician Rene De Los Rios of five felony counts for his role in a $23...

Other Issuances: CMS posts new NCCI files, releases HAC data, and issues preventive services guidance

  • Medicare Insider, Issue 15, April 12, 2011

    CMS has released the quarterly update to the NCCI edits, up to v. 17.0 for hospital outpatient...

Transmittals/MLN Matters articles: CMS posts special article on PCIP, instructs on MRI coverage, and more

  • Medicare Update for Physician Services, Issue 4, April 7, 2011

    CMS has posted a special edition MLN Matters article on the primary care incentive payment program...

Events: February 22 Open Door Forum transcript available

  • Medicare Update for Physician Services, Issue 4, April 7, 2011

    MedicareFind subscribers can now access the transcript and audio of the Physicians, Nurses, and...

Other developments: CMS issues drug billing FAQs, addresses eRx incentives

  • Medicare Update for Physician Services, Issue 4, April 7, 2011

    CMS’ physician regulatory issues team (PRIT) recently addressed the question of whether a...

Quarterly updates: CMS updates RVU file, MUEs, lab fee schedule, and more

  • Medicare Update for Physician Services, Issue 4, April 7, 2011

    CMS has posted an update to the clinical laboratory fee schedule (CLFS) file.

CMS explains new provider enrollment provisions

  • Compliance Monitor, Issue 14, April 6, 2011

    CMS has issued MLN Matters Article MM7350 to explain how the new provider enrollment provisions...

Note: Implementation of the critical care composite APC

  • Medicare Insider, Issue 14, April 5, 2011

    My colleague, Judith Kares, wrote about the new CPT guidance on critical care for 2011 and the...

Physician arrested for conspiring to distribute controlled substances

  • Compliance Monitor, Issue 13, March 30, 2011

    The Greater Palm Beach Health Care Fraud Task Force arrested Selwyn Carrington, MD, 57, of Miami...

Regulations: CMS posts 2011 Medicare enrollment application fee

  • Medicare Insider, Issue 13, March 29, 2011

    On March 23, CMS published in the Federal Register a notice to announce the $505 calendar year...

Transmittals and MLN Matters articles: CMS issues consolidated billing, drug pricing updates, and more

  • Medicare Insider, Issue 13, March 29, 2011

    On March 25, CMS issued a transmittal to update the list of HCPCS codes subject to the skilled...

Other Issuances: CMS updates lab edit module

  • Medicare Insider, Issue 13, March 29, 2011

    CMS has released the most recent version of its lab NCD manual.

CMS Public Events: None this week

  • Medicare Insider, Issue 13, March 29, 2011

    There are no public events this week.

MedicareMentor Blog spotlight: Signature requirement for lab requisitions

  • Medicare Insider, Issue 13, March 29, 2011

    Those of us who have wondered what the outcome will be of CMS’ three-month delay in...

Mentor moment: Going beyond the common medical necessity thought process

  • Case Management Weekly, Issue 12, March 23, 2011

    Medical necessity acquires new meaning in the context of recent MAC, RAC, and CERT denials of...

Transmittals and MLN Matters articles: CMS issues quarterly updates to OPPS, NCCI, and more

  • Medicare Insider, Issue 12, March 22, 2011

    On March 18, CMS issued a transmittal to make quarterly updates to the OPPS for April. The...

Transmittals and MLN Matters articles: CMS updates outpatient code editor, instructs on place-of-service coding

  • Medicare Insider, Issue 11, March 15, 2011

    CMS has released a special edition MLN Matters article on place-of-service coding in response to...

MedicareMentor Blog spotlight: Observation patients

  • Medicare Insider, Issue 11, March 15, 2011

    After having discussions with the Medicare Specialist and Nurse Auditor at my facility, I was...

Regulations: CMS issues OPPS corrections

  • Medicare Insider, Issue 11, March 15, 2011

    On March 11, CMS published in the Federal Register corrections to the 2011 OPPS final rule.

Note: Medicare issues a reminder on the importance of billing the correct place of service on physician claims

  • Medicare Insider, Issue 11, March 15, 2011

    In a recent MLN Matters article, Medicare once again reminded physicians and their billing agents...

Sen. Grassley introduces new Medicare and Medicaid fraud legislation

  • Compliance Monitor, Issue 10, March 9, 2011

    Senator Chuck Grassley introduced legislation to build on key reforms to fight fraud in Medicare...

Tip: Get support from the top

  • Compliance Monitor, Issue 10, March 9, 2011

    One crucial element of a good compliance program is having a supportive board and senior management.

Regulations: No issuances this week

  • Medicare Insider, Issue 10, March 8, 2011

    CMS issued no significant regulations affecting hospital billing this week.

CMS Public Events: February 23 Hospital Open Door Forum transcript available

  • Medicare Insider, Issue 10, March 8, 2011

    MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Note: Reporting time for drug administration services

  • Medicare Insider, Issue 10, March 8, 2011

    This week I thought I’d take the opportunity to address a confusing coding issue related to...

Quarterly update: CMS issues lab/drug updates and more

  • Medicare Update for Physician Services, Issue 3, March 3, 2011

    On February 11, CMS issued a transmittal to inform contractors of new waived tests approved by the...

Transmittals/MLN Matters articles: CMS updates annual wellness visit transmittals, instructs on -GZ denials, and more

  • Medicare Update for Physician Services, Issue 3, March 3, 2011

    On February 25, CMS issued a transmittal to instruct its auditing contractors (e.g., RAC, CERT...

Other developments: CMS announces reprocessing plan, introduces esMD, and more

  • Medicare Update for Physician Services, Issue 3, March 3, 2011

    CMS has issued its second edition of its provider compliance newsletter. This issue features...

Note from Peggy: ABNs and modifiers

  • Medicare Update for Physician Services, Issue 3, March 3, 2011

    While advance beneficiary notices (ABN) have been simplified with the implementation of the...

Illinois Blue Cross agrees to pay $25M to settle false claims charges

  • Compliance Monitor, Issue 9, March 2, 2011

    Blue Cross Blue Shield of Illinois will pay the United States and the state of Illinois $25 million...

Q&A: What is esMD?

  • Compliance Monitor, Issue 9, March 2, 2011

    Q: What is esMD and how can my hospital sign up?

Note: Medicare clarifies benefit for annual wellness visit, including personalized prevention plan services

  • Medicare Insider, Issue 9, March 1, 2011

    In two recent transmittals (and a related MLN Matters article) Medicare clarified its new benefit...

Other Issuances: CMS delays Medicaid RACs, issues provider compliance newsletter

  • Medicare Insider, Issue 9, March 1, 2011

    CMS posted a letter to delay the timeline for implementation of the Medicaid RACs. States will not...

Transmittals and MLN Matters articles: CMS instructs on use of claims history, updates underpayment guidance, and more

  • Medicare Insider, Issue 9, March 1, 2011

    On February 25, CMS issued a transmittal to instruct its auditing contractors (e.g., RAC, CERT...

Medicare Fraud Strike Force charges 111 in the country's largest healthcare fraud takedown

  • Compliance Monitor, Issue 8, February 23, 2011

    The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged...

MedicareFind Forum Spotlight: CLIA waived tests

  • Medicare Insider, Issue 8, February 22, 2011

    How should we bill Medicare for clia waived tests in a provider based clinic?  Should it be...

Georgia hospital system pays $2.7 million to settle inappropriate billing charges

  • Compliance Monitor, Issue 7, February 16, 2011

    St. Joseph’s/Candler Health System (SJCHS) agreed to pay $2.7million to settle allegations...

Medical assistant sentenced to 3 years in prison for Medicare fraud scheme

  • Compliance Monitor, Issue 7, February 16, 2011

    Guy Ross, 51, a Detroit-area medical assistant, will serve 36 months in prison and pay $472,000 in...

Transmittals and MLN Matters articles: CMS replaces transmittal, posts MLN articles

  • Medicare Insider, Issue 7, February 15, 2011

    CMS rescinded and replaced a transmittal previously outlined in Medicare Weekly Update.

Note: Determining inpatient medical necessity for procedures

  • Medicare Insider, Issue 7, February 15, 2011

    CMS was very quiet during the past week. That tends to make me a little nervous – you know...

Other Issuances: No releases this week

  • Medicare Insider, Issue 6, February 8, 2011

    Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

CMS Public Events: None this week

  • Medicare Insider, Issue 6, February 8, 2011

    There are no public events this week.

Note: CMS orders all contractors to automatically deny claim line items submitted with a -GZ modifier

  • Medicare Insider, Issue 6, February 8, 2011

    In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs, PSCs...

Transmittals/MLN Matters articles: CMS implements timely filing changes, establishes lab payment demonstration, and more

  • Medicare Update for Physician Services, Issue 2, February 3, 2011

    On January 28, CMS issued two transmittals to put in place a demonstration project for certain...

Quarterly updates: CMS updates interest rates, lab NCDs

  • Medicare Update for Physician Services, Issue 2, February 3, 2011

    On January 14, CMS issued a transmittal to implement a quarterly update to the interest rate that...

Events: January 11 Physician Open Door Forum transcript available

  • Medicare Update for Physician Services, Issue 1, February 3, 2011

    MedicareFind subscribers can now access the transcript and audio of the Physicians, Nurses and...

Regulations: CMS withdraws advance care planning, publishes screening final rule, and more

  • Medicare Update for Physician Services, Issue 2, February 3, 2011

    CMS has issued a display copy of a final rule to implement provisions of the Patient Protection...

Note: Inpatient-only procedures and the three-day rule

  • Medicare Insider, Issue 5, February 1, 2011

    CMS has clarified that outpatient procedures that meet preadmission packaging requirements and...

Other Issuances: CMS issues anesthesia guidance, CLIA memo

  • Medicare Insider, Issue 5, February 1, 2011

    On January 14, CMS issued a memorandum to state survey directors to further clarify requirements...

Transmittals and MLN Matters articles: CMS posts special article on admission screening criteria, implements lab payment demonstration, and more

  • Medicare Insider, Issue 5, February 1, 2011

    CMS has posted a special edition MLN Matters article on inpatient admission decisions and the use...

Regulations: CMS posts IPF PPS proposed rule, screening requirements final rule

  • Medicare Insider, Issue 5, February 1, 2011

    CMS has issued a display copy of a final rule to implement provisions of the Patient Protection...

CMS Public Events: January 13 Hospital Open Door Forum transcript available

  • Medicare Insider, Issue 4, January 25, 2011

    MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

MedicareMentor Blog Spotlight: Annual wellness visit

  • Medicare Insider, Issue 4, January 25, 2011

    What diagnosis code should be used with the G0438 procedure code?

Transmittals and MLN Matters articles: CMS makes timely filing changes, modifies IPPS Pricer, and more

  • Medicare Insider, Issue 4, January 25, 2011

    On January 21, CMS issued a transmittal to update its manual system with changes to the timely...

Note: CMS clarifies payment for CRNA Services in a CAH and transmittal dates

  • Medicare Insider, Issue 4, January 25, 2011

    Critical access hospitals (CAHs) are hospitals that have met very specific requirements &ndash...

Next month in Briefings on Coding Compliance Strategies

  • Compliance Monitor, Issue 3, January 19, 2011

    Every month, Compliance Monitor provides a sneak peek at the upcoming issue of Briefings on Coding...

Medical supply company owner sentenced to three years for Part D fraud

  • Compliance Monitor, Issue 3, January 19, 2011

    Renier Vicente Rodriguez Fleitas, 60, of Miami-Dade County, will serve 37 months after pleading...

Note:CMS issues proposed rule on value-based incentive payments to acute care hospitals under the IPPS

  • Medicare Insider, Issue 3, January 18, 2011

    As part of its continuing efforts to forge a closer link between Medicare’s payment systems...

Regulations: CMS removes advance care planning from annual wellness visit, publishes value-based purchasing proposal

  • Medicare Insider, Issue 3, January 18, 2011

    On January 13, CMS published in the Federal Register a proposed rule that would establish a...

Regulations: CMS proposes value-based purchasing, finalizes permanent HIT certification rule, and more

  • Medicare Insider, Issue 2, January 11, 2011

    On January 7, CMS issued a display copy of a proposed rule that would establish a hospital...

Transmittals and MLN Matters articles: CMS updates OPPS, issues MLN Matters articles, and more

  • Medicare Insider, Issue 2, January 11, 2011

    On December 30, CMS issued two transmittals to implement updates to the OPPS for 2011. Changes...

Note: Implementation of the CY 2011 OPPS final rule begins

  • Medicare Insider, Issue 2, January 11, 2011

    As you are aware, the most significant changes to the Medicare rules that apply to outpatient...

Note from Peggy: New benefit for annual wellness visit

  • Medicare Update for Physician Services, Issue 1, January 6, 2011

    Happy new year and welcome to a new Medicare benefit in the form of an annual wellness visit...

Transmittals/MLN Matters articles: CMS addresses ordering/referring providers, ABN validity assessments, and more

  • Medicare Update for Physician Services, Issue 1, January 6, 2011

    On December 17, CMS issued a transmittal to incorporate a table of therapy CPT codes indicating...

Quarterly updates: CMS implements 2011 MPFS, posts lab travel allowance

  • Medicare Update for Physician Services, Issue 1, January 6, 2011

    On December 29, CMS issued a transmittal to post implement policy changes under the MPFS for 2011.

Events: Physician Open Door Forum January 11

  • Medicare Update for Physician Services, Issue 1, January 6, 2011

    The next Physician, Nurses and Allied Health Professionals Open Door Forum is scheduled for...

Seven hospitals to pay more than $6.3 million to resolve False Claims Act allegations related to kyphoplasty

  • Compliance Monitor, Issue 1, January 5, 2011

    Seven hospitals agreed to pay the United States a total of more than $6.3 million to settle...

Q&A: How should providers prepare for Medicaid RACs?

  • Compliance Monitor, Issue 1, January 5, 2011

    Q: How should providers prepare for Medicaid RACs?

Transmittals and MLN Matters articles: CMS posts new cost report, issues emergency MPFS update, and more

  • Medicare Insider, Issue 1, January 4, 2011

    On December 30, CMS issued a transmittal to implement a new hospital cost report (CMS-2552-10...

Other Issuances: CMS issues lab NCD manual

  • Medicare Insider, Issue 1, January 4, 2011

    CMS has issued the lab NCD manual for the first quarter of 2011.

Note: The year in review

  • Medicare Insider, Issue 1, January 4, 2011

    I hope you had a wonderful holiday and started the new year in style!  Things were pretty...

Other Issuances: CMS issues OCE specifications, announces EHR registration date

  • Medicare Insider, Issue 52, December 28, 2010

    CMS announced the availability of registration for the Medicare electronic health record (EHR...

Transmittals and MLN Matters articles: CMS replaces transmittals, posts MLN Matters articles

  • Medicare Insider, Issue 52, December 28, 2010

    CMS replaces transmittals, issues MLN Matters article

Sebelius and Holder seek new tools to prevent and fight fraud

  • Compliance Monitor, Issue 48, December 22, 2010

    CMS is looking to acquire new state-of-the-art fraud fighting tools to prevent wasteful and...

Detroit-area doctor sentenced to 36 months in prison for Medicare fraud scheme

  • Compliance Monitor, Issue 48, December 22, 2010

    Alan Silber, MD, will serve 36 months in prison for participating in a scheme to defraud the...

Other Issuances: CAHs to receive PEPPER data, OIG audits device replacement

  • Medicare Insider, Issue 51, December 21, 2010

    TMF announced several updates to the Program for Evaluating Payment Patterns Electronic Report...

Note: PEPPERs are coming to CAHs

  • Medicare Insider, Issue 51, December 21, 2010

    Last week, it was announced that critical access hospitals (CAHs) will be able to add a little...

Kos Pharmaceuticals to pay more than $41 million to resolve kickback and off-label promotion allegations

  • Compliance Monitor, Issue 47, December 15, 2010

    Kos Pharmaceuticals agreed to pay more than $41 million to resolve claims that it offered illegal...

Regulations: No issuances this week

  • Medicare Insider, Issue 50, December 14, 2010

    CMS issued no significant regulations affecting hospital billing this week.

Note: Face validity assessment of ABNs required on all complex medical reviews

  • Medicare Insider, Issue 50, December 14, 2010

    Last Friday, CMS issued transmittal R361PI requiring mandatory advanced beneficiary notices (ABNs...

Transmittals and MLN Matters articles: CMS requires ABN assessment for complex medical review, clarifies "incident to" drug billing, and more

  • Medicare Insider, Issue 50, December 14, 2010

    On December 10, CMS issued a transmittal to require that medical reviewers request all a mandatory...

Note: CMS issues implementing instructions for new annual wellness visit

  • Medicare Insider, Issue 49, December 7, 2010

    This week CMS released 2 transmittals implementing the Annual Wellness Visit (AWV), including...

Transmittals and MLN Matters articles: CMS posts special RAC article, implements annual wellness visit benefit, and more

  • Medicare Insider, Issue 49, December 7, 2010

    On December 2, CMS issued the latest in a series of RAC program special MLN Matters articles. The...

Events: November 16 Physician Open Door Forum transcript/audio available

  • Medicare Update for Physician Services, Issue 12, December 2, 2010

    The transcript and audio recording of the November 16 Physicians, Nurses, and Allied Health...

Other developments: Congress extends payment fix, CMS posts 2011 RVUs, and more

  • Medicare Update for Physician Services, Issue 12, December 2, 2010

    Congress has extended the physician payment "doc" fix through the end of the year. Under...

Quarterly updates: CMS implements lab update, posts NCCI update, and more

  • Medicare Update for Physician Services, Issue 12, December 2, 2010

    On November 24, CMS issued a transmittal to provide instructions for the CY 2011 clinical...

Transmittals and MLN Matters articles: CMS clarifies PET billing, posts new vaccine codes, and more

  • Medicare Update for Physician Services, Issue 12, December 2, 2010

    On November 23, CMS posted a previously sensitive transmittal to implement a new modifier and...

Regulations: CMS publishes Medicaid RAC proposal, MPFS rule, and more

  • Medicare Update for Physician Services, Issue 12, December 2, 2010

    On November 5, CMS posted a proposed rule regarding the RAC expansion into Medicaid. The rule...

DOJ recovers $2.5 billion in healthcare fraud via False Claims Act

  • Compliance Monitor, Issue 45, December 1, 2010

    The Department of Justice (DOJ) recovered $2.5 billion in healthcare fraud recoveries for fiscal...

Florida-based Medicare Advantage plan owners and provider agree to $22.6 million settlement

  • Compliance Monitor, Issue 45, December 1, 2010

    Walter Janke, MD, his wife, Lalita Janke, and Medical Resources LLC agreed to pay $22.6 million to...

Transmittals and MLN Matters articles: CMS updates lab fee schedule, creates oil spill modifier/condition code, and more

  • Medicare Insider, Issue 48, November 30, 2010

    On November 24, CMS issued a transmittal to provide instructions for the CY 2011 clinical...

Other Issuances: OIG reviews devices and more

  • Medicare Insider, Issue 48, November 30, 2010

    On November 19, the OIG issued a review of UMass Memorial Medical Center claims for outpatient...

Regulations: No issuances this week

  • Medicare Insider, Issue 48, November 30, 2010

    CMS issued no significant regulations affecting hospital billing this week.

Note: Signature requirements for lab requisitions

  • Medicare Insider, Issue 48, November 30, 2010

    Discussions regarding signature requirements for laboratory services have been going on for the...

Ameritox, Ltd. pays $16.3 million to resolve kickback claims

  • Compliance Monitor, Issue 44, November 24, 2010

    Ameritox, Ltd., a laboratory based in Midland, TX, agreed to pay the U.S. government $16.3 million...

Note: CY2011 deductibles and coinsurance amounts, thoughts on physician supervision

  • Medicare Insider, Issue 47, November 23, 2010

    This week, CMS published the transmittal with new manual sections implementing the new deductibles...

Transmittals and MLN Matters articles: CMS posts new vaccine codes, implements CAH payments changes, and more

  • Medicare Insider, Issue 47, November 23, 2010

    On November 19, CMS issued a transmittal to implement new HCPCS Q codes for 2010-2011 seasonal...

Regulations: CMS posts premiums, coinsurance rates for 2011

  • Medicare Insider, Issue 46, November 16, 2010

    On November 9, CMS published three notices in the Federal Register to set various premium...

Transmittals and MLN Matters articles: CMS expands IPPS transfer policy, issues article on ICD-10 implementation, implements edits, and more

  • Medicare Insider, Issue 46, November 16, 2010

    On November 12, CMS issued a transmittal to expand the current IPPS transfer policy. Currently, a...

Note: CY 2011 OPPS final rule billing changes for 'included services' provided during critical care

  • Medicare Insider, Issue 46, November 16, 2010

    As you are probably aware, CMS issued a display copy of the CY 2011 OPPS final rule on November...

CA hospital settles Medicare fraud case for $5.1M

  • Compliance Monitor, Issue 42, November 10, 2010

    Simi Valley (CA) Hospital paid the United States $5.1 million to resolve allegations that its...

Regulations: CMS issues Medicaid RAC proposals, posts OPPS final rule, and more

  • Medicare Insider, Issue 45, November 9, 2010

    On November 5, CMS posted a proposed rule regarding the RAC expansion into Medicaid. The rule...

Transmittals and MLN Matters articles: CMS issues MLN Matters articles, and more

  • Medicare Insider, Issue 45, November 9, 2010

    On October 29, CMS issued a transmittal to instruct contractors that, for discharges on or after...

CMS Public Events: No events this week

  • Medicare Insider, Issue 45, November 9, 2010

    There are no public events this week.

Note: OPPS final rule and physician supervision

  • Medicare Insider, Issue 45, November 9, 2010

    It’s here!  The OPPS final rule has been published in a display copy for your review as...

Other developments: OIG audits neulasta, and more

  • Medicare Update for Physician Services, Issue 11, November 4, 2010

    On October 7, the OIG issued a review of use of Medicare fee-for-service (FFS) error rate data to...

Quarterly updates: CMS issues new interest rate, posts flu vaccine transmittal, and more

  • Medicare Update for Physician Services, Issue 11, November 4, 2010

    On October 22, CMS issued a transmittal to provide updated payment allowances for seasonal...

Regulations: CMS posts MPFS final rule

  • Medicare Update for Physician Services, Issue 11, November 4, 2010

    On November 2, CMS issued a display copy of the CY 2011 MPFS final rule.

Transmittals and MLN Matters articles: CMS implements edit for pathology services, and more

  • Medicare Update for Physician Services, Issue 11, November 4, 2010

    On October 29, CMS implemented an edit to prevent payments for the technical component of...

Events: October 5 Physician Open Door Forum transcript/audio available

  • Medicare Update for Physician Services, Issue 11, November 4, 2010

    The next Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for...

Christ Hospital enters five-year CIA to resolve anti-kickback case

  • Compliance Monitor, Issue 41, November 3, 2010

    The Christ Hospital (TCH) of Cincinnati, OH, and the Office of Inspector General (OIG) entered into...

Transmittals and MLN Matters articles: CMS issues guidance on the three-day rule, revises documentation/coding guidance, implements point-of-origin updates, and more

  • Medicare Insider, Issue 44, November 2, 2010

    On October 29, CMS issued a transmittal to provide guidance on the three-day payment window, as...

Regulations: No issuances this week

  • Medicare Insider, Issue 44, November 2, 2010

    CMS issued no significant regulations affecting hospital billing this week.

Other Issuances: No releases this week

  • Medicare Insider, Issue 44, November 2, 2010

    Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

MedicareFind Forum Spotlight: EOMBs

  • Medicare Insider, Issue 44, November 2, 2010

    Weigh in on a recent MedicareFind Forum question: Are paper EOMBs required under Medicare? Read...

MedicareFind Forum Spotlight: Pulmonary rehab

  • Medicare Insider, Issue 43, October 26, 2010

    On a CMS transmittal it states that G0424 takes effective 1/1/10 for claims processed on or after...

Transmittals and MLN Matters articles: CMS updates interest rate, posts MLN Matters articles, and more

  • Medicare Insider, Issue 43, October 26, 2010

    On October 18, CMS issued a transmittal to instruct contractors to implement an interest rate of...

Note: Physician supervision and H.R. 6376

  • Medicare Insider, Issue 43, October 26, 2010

    It was a relatively quite week again for CMS as we wait for the OPPS final rule to be announced...

Transmittals and MLN Matters articles: CMS implements revenue codes, issues EHR instructions, and more

  • Medicare Insider, Issue 42, October 19, 2010

    On October 15, CMS issued a one-time notification to implement new revenue codes created by the...

Transmittals and MLN Matters articles: CMS updates OPPS hook and hold, reissues transmittals, and more

  • Medicare Insider, Issue 41, October 12, 2010

    On October 6, CMS posted a special MLN Matters article directing providers to available resources...

Note: CMS publishes first quarterly compliance newsletter; update on three-day rule and physician offices

  • Medicare Insider, Issue 41, October 12, 2010

    First, CMS published a new document this week called the “Medicare Quarterly Provider...

Transmittals and MLN Matters articles: CMS MLN Matters articles on ICR programs, CPT code 80101, and FDG PET for initial treatment strategy in tumors and myeloma

  • Medicare Insider, Issue 40, October 5, 2010

    Transmittals and MLN Matters articles: CMS MLN Matters articles on ICR programs, CPT code 80101...

Other Issuances: OIG releases 2011 Work Plan, CMS announces SHIP funding awards, NCD lab manual quarterly update, quarterly OPPS updates, quarterly MUE files, new FAQs, and more

  • Medicare Insider, Issue 40, October 5, 2010

    Other Issuances: OIG releases 2011 Work Plan, CMS announces SHIP funding awards, NCD lab manual...

CMS Public Events: Hospital Open Door Forum October 7

  • Medicare Insider, Issue 40, October 5, 2010

    The next Hospital & Hospital Quality Open Door Forum conference call will be held 2 - 3 pm...

MedicareFind Forum Spotlight: Swing bed scenario

  • Medicare Insider, Issue 39, September 28, 2010

    How do you handle a Medicare swing bed patient that requires heart cath at another facility?

Transmittals and MLN Matters articles: CMS posts RAC articles, issues condition code 44 language, suspends automatic -GA denials, and more

  • Medicare Insider, Issue 39, September 28, 2010

    On September 17, CMS issued its quarterly OPPS update instructions, which includes additional...

Regulations: No issuances this week

  • Medicare Insider, Issue 38, September 21, 2010

    CMS issued no significant regulations affecting hospital billing this week.

Transmittals and MLN Matters articles: CMS updates I/OCE, reason codes, and more

  • Medicare Insider, Issue 37, September 14, 2010

    On September 3, CMS posted a transmittal to implement the quarterly update to the integrated...

Other Issuances: CMS updates three-day rule guidance, OIG audits bad debt

  • Medicare Insider, Issue 37, September 14, 2010

    On September 9, CMS posted a message to its acute care hospital listserv to clarify and announce...

CMS Public Events: August 26 Hospital Open Door Forum transcript available

  • Medicare Insider, Issue 37, September 14, 2010

    MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Regulations: No issuances this week

  • Medicare Insider, Issue 36, September 7, 2010

    CMS issued no significant regulations affecting hospital billing this week.

Transmittals and MLN Matters articles: CMS instructs on discarded drugs/biologicals, implements ESRD PPS

  • Medicare Insider, Issue 35, August 31, 2010

    On August 20, CMS issued a transmittal instructing contractors to provide local guidance on the...

Note: ESRD PPS final rule released effective for CY 2011

  • Medicare Insider, Issue 35, August 31, 2010

    CMS recently released the ESRD PPS final rule, which will become effective for services provided on...

CMS Public Events: Hospital Open Door Forum August 26

  • Medicare Insider, Issue 34, August 24, 2010

    The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, August 26...

Note: Just one week left to submit comments on the 2011 OPPS proposed rule!

  • Medicare Insider, Issue 34, August 24, 2010

    With just a week left to submit comments on the OPPS Proposed Rule for CY 2011, this seems a good...

Transmittals and MLN Matters articles: CMS revises POA process, updates IRF PPS, issues special article on medical record retention, and more

  • Medicare Insider, Issue 33, August 17, 2010

    On August 10, CMS issued a special edition MLN Matters article on medical record retention and...

Regulations: CMS publishes final rules for FY 2011 IPPS, ESRD PPS

  • Medicare Insider, Issue 33, August 17, 2010

    On August 16, CMS published in the Federal Register a final rule making changes to the IPPS for...

CMS Public Events: No events this week

  • Medicare Insider, Issue 33, August 17, 2010

    There are no public events this week.

Transmittals and MLN Matters articles: CMS replaces ICD-9-CM transmittal, modifies pricers, and more

  • Medicare Insider, Issue 32, August 10, 2010

    On August 4, CMS issued a transmittal to replace its previous instruction regarding implementation...

MedicareFind Forum Spotlight: Dental Claims

  • Medicare Insider, Issue 32, August 10, 2010

    At one time Dental services were not covered by Medicare in an hospital.  We  billed...

Regulations: CMS publishes 2011 OPPS proposed rule

  • Medicare Insider, Issue 32, August 10, 2010

    On August 3, CMS published in the Federal Register the 2011 OPPS proposed rule (CMS-1504-P). Among...

Note: 2011 IPPS Final Rule includes Interim Final Rule on Three Day Window

  • Medicare Insider, Issue 31, August 3, 2010

    Although I haven’t digested the 1,877 pages of the display copy of the 2011 IPPS Final Rule...

MedicareFind Forum Spotlight: Self-administered drugs

  • Medicare Insider, Issue 31, August 3, 2010

    I would like to know how other hospitals are addressing self administered drugs  (SAD) in...

CMS Public Events: No events this week

  • Medicare Insider, Issue 31, August 3, 2010

    There are no public events this week.

CMS releases tip sheets for EHR incentive program

  • Medicare Insider, Issue 31, August 3, 2010

    CMS has posted several tip sheets aimed at explaining the EHR incentive program to hospitals.

Transmittals and MLN Matters articles: CMS instructs on timely filing, implements IPF interrupted stay policy, and more

  • Medicare Insider, Issue 31, August 3, 2010

    On July 30, CMS issued a transmittal to make changes to the common working file (CWF) regarding...

Regulations: CMS releases 2011 IPPS rulemaking, publishes EHR rule, and more

  • Medicare Insider, Issue 31, August 3, 2010

    On July 28, CMS published in the Federal Register a final rule to define “meaningful...

CMS Public Events: Hospital Open Door Forum transcript available

  • Medicare Insider, Issue 30, July 27, 2010

    MedicareFind subscribers now have access to the written transcript and audio recording of the...

Transmittals and MLN Matters articles: CMS updates SOM, issues quarterly lab NCD and interest rate update, and more

  • Medicare Insider, Issue 30, July 27, 2010

    On July 16, CMS issued a transmittal to revise the State Operations Manual, making changes that...

Regulations: CMS publishes IRF PPS update in Federal Register

  • Medicare Insider, Issue 30, July 27, 2010

    On July 22, CMS published in the Federal Register a notice to update the inpatient rehabilitation...

Note: Latest CMS transmittal changes OPPS rates - again

  • Medicare Insider, Issue 30, July 27, 2010

    Last week, we talked about the changes that CMS announced under the Patient Protection and...

Regulations: CMS, HHS post EHR incentive program final rules, CMS issues IRF PPS update, and more

  • Medicare Insider, Issue 29, July 20, 2010

    On July 16, CMS issued a display copy of a notice to update the inpatient rehabilitation facility...

Other Issuances: OIG analyzes 2009 CERT errors

  • Medicare Insider, Issue 29, July 20, 2010

    On July 14, the OIG issued an analysis of errors identified in the fiscal year 2009 comprehensive...

Other Issuances: OIG posts audits of IRF transfers, oxaliplatin, and more

  • Medicare Insider, Issue 28, July 13, 2010

    On June 29, the OIG issued a review of inpatient rehabilitation facilities’ (IRF) compliance...

Transmittals and MLN Matters articles: CMS posts MRA coverage changes, implements PPACA changes, and more

  • Medicare Insider, Issue 28, July 13, 2010

    On July 9, CMS issued transmittals to the National Coverage Determinations Manual and the Claims...

Regulations: HHS releases HIT certification rule, CMS posts IPPS corrections

  • Medicare Insider, Issue 25, June 22, 2010

    On June 18, HHS released a display copy of the final rule establishing a temporary certification...

CMS Public Events: Hospital ODF transcript available

  • Medicare Insider, Issue 24, June 15, 2010

    MedicareFind subscribers now have access to the written transcript and audio recording of the...

MedicareFind spotlight: PRRB decisions

  • Medicare Insider, Issue 24, June 15, 2010

    MedicareFind users can now access appeals decisions made by the Provider Reimbursement Review...

Note: CMS clarifies "immediate availability" and identifies supervisory practitioner qualifications for both diagnostic and therapeutic outpatient hospital services

  • Medicare Insider, Issue 24, June 15, 2010

    Last week we discussed CMS’ clarifications regarding supervision requirements for hospital...

Regulations: CMS IPPS notice, proposals under PPACA

  • Medicare Insider, Issue 23, June 8, 2010

    On June 2, CMS published in the Federal Register two entries that would make changes to the IPPS...

Transmittals and MLN Matters articles: CMS issues supervision guidance, issues NCDs, and more

  • Medicare Insider, Issue 23, June 8, 2010

    On May 28, CMS issued the July update to the OPPS for the Benefit Policy Manual, in which it...

CMS Public Events: RAC 101, Physician ODF transcripts available

  • Medicare Insider, Issue 23, June 8, 2010

    MedicareFind subscribers can now access the written transcripts of the nationwide RAC 101 call...

Note: Proposed Revisions to the Three-Day Payment Window

  • Medicare Insider, Issue 21, May 25, 2010

    The three-day payment window, sometimes known incorrectly as the “72-hour rule,” has...

CMS Public Events: Hospital Open Door Forum Thursday, RAC 101 call transcript available

  • Medicare Insider, Issue 21, May 25, 2010

    The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, May 27, 2010...

MedicareFind tip: How to track health reform updates

  • Medicare Insider, Issue 21, May 25, 2010

    The recently enacted Patient Protection and Affordable Care Act (and companion Health Care and...

Regulations: CMS issues PPACA rulemaking, proposes CoP changes

  • Medicare Insider, Issue 21, May 25, 2010

    On May 21, CMS issued display copies of two Federal Register entries that would make changes to...

Other Issuances: OIG reviews excessive outpatient claims, and more

  • Medicare Insider, Issue 20, May 18, 2010

    CMS has issued revised Addendum A and Addendum B data files to reflect changes under the Patient...

Transmittals and MLN Matters articles: CMS issues MLN Matters articles on timely filing under PPACA, multiple procedure payment reduction, HIV screening, and more

  • Medicare Insider, Issue 20, May 18, 2010

    CMS released several MLN Matters articles related to transmittals previously outlined in Medicare...

Note: Opportunity to update Medicare Advantage patient information needed to determine Medicare disproportionate share (DSH) payments for FYs 2007 and 2008 expires August 31, 2010

  • Medicare Insider, Issue 20, May 18, 2010

    In transmittal R696OTN published earlier this month, Medicare reminded hospitals of the...

Transmittals and MLN Matters articles: CMS issues pulmonary rehab transmittals, implements new timely filing requirements, and more

  • Medicare Insider, Issue 19, May 11, 2010

    On May 7, CMS issued transmittals to the Claims Processing Manual and Benefit Policy Manual to...

Regulations: CMS issues PPACA enrollment rulemaking, publishes IPPS proposed rule

  • Medicare Insider, Issue 19, May 11, 2010

    On May 5, CMS published in the Federal Register an interim final rule to implement various...

Note: Clarification on Discarded Drugs

  • Medicare Insider, Issue 18, May 4, 2010

    This week CMS issued clarification on a couple of drug billing related issues.  In Claims...

Regulations: CMS publishes IPF PPS update for 2011, OCR asks for information on accounting of disclosures

  • Medicare Insider, Issue 18, May 4, 2010

    On May 3, the Office for Civil Rights (OCR) published in the Federal Register a request for...

Transmittals and MLN Matters articles: CMS instructs on discarded drugs/biologicals, addresses self-administered drugs, and more

  • Medicare Insider, Issue 18, May 4, 2010

    On April 30, CMS issued a transmittal to clarify what “administered” means in the...

Regulations: CMS issues 2011 IPPS proposed rule

  • Medicare Insider, Issue 17, April 27, 2010

    CMS has posted a display copy of proposed rulemaking under the IPPS for FY 2011.

Note: FY 2011 inpatient rule has payment reductions for PPS providers, clarification for CAHs

  • Medicare Insider, Issue 17, April 27, 2010

    The FY 2011 IPPS proposed rule contains a reduction in the standardized amount reflecting an...

Transmittals and MLN Matters articles: CMS revises several previous transmittals and issues MLN Matters article on Medicare coverage of blood glucose monitors and testing supplies

  • Medicare Insider, Issue 16, April 20, 2010

    Transmittals and MLN Matters articles: CMS revises several previous transmittals and issues MLN...

Regulations: CMS posts 2011 payment policies for Medicare Advantage, prescription drugs

  • Medicare Insider, Issue 15, April 13, 2010

    CMS released a display copy of rulemaking containing the capitation rates for Medicare Advantage...

Transmittals and MLN Matters articles: CMS instructs on patients in custody, issues MLN Matters article on recoupment, and more

  • Medicare Insider, Issue 15, April 13, 2010

    On April 9th, CMS issued a transmittal notifying A/B MAC/carriers to continue to pay the technical...

Other Issuances: Region D RAC updates audit issue description

  • Medicare Insider, Issue 15, April 13, 2010

    Health Data Insights, the Region D RAC, has updated its description of an existing audit issue.

CMS Public Events: Physician Open Door Forum, RAC educational calls, and more

  • Medicare Insider, Issue 15, April 13, 2010

    The next Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for...

Transmittals and MLN Matters articles: CMS instructs on cardiac defibrillator services, affirms PET coverage policy, and more

  • Medicare Insider, Issue 13, March 30, 2010

    On March 26, CMS issued a transmittal to update the list of ICD-9-CM diagnosis codes not requiring...

Note: Appeals council issues a "partially favorable" decision

  • Medicare Insider, Issue 13, March 30, 2010

    The Medicare Appeals Council has issued a decision on one of the many outstanding appeals from the...

Other Issuances: CMS delays CAH supervision enforcement, RAC updates audit issues, and more

  • Medicare Insider, Issue 12, March 23, 2010

    On March 15, CMS issued a notice to Congress that it had instructed its contractors not to evaluate...

Transmittals and MLN Matters articles: CMS revises signature requirements, issues lab coding guidance, and more

  • Medicare Insider, Issue 12, March 23, 2010

    On March 19, CMS issued a transmittal to communicate new edit spreadsheets to contractors able to...

MedicareFind Forum: Post a question

  • Medicare Insider, Issue 12, March 23, 2010

    The MedicareFind Forum is a free resource where you can ask and answer Medicare-related questions...

Note: Signatures should be audited

  • Medicare Insider, Issue 12, March 23, 2010

    In the current regulatory environment there are many contractors that are charged with reviewing...

MedicareFind Demonstration April 6

  • Medicare Insider, Issue 12, March 23, 2010

    Join us Tuesday, April 6, to learn more about how MedicareFind™ can help you find the...

Transmittals and MLN Matters articles: CMS to implement expanded ICD-9 processing, revise PTA and cardiac rehab coverage, and more

  • Medicare Insider, Issue 11, March 16, 2010

    On March 5, CMS issued a transmittal to implement processing of more ICD-9 codes (diagnosis and...

CMS Public Events: Hospital Open Door Forum transcript/recording available

  • Medicare Insider, Issue 11, March 16, 2010

    A transcript and audio recording of the March 4 Hospital & Hospital Quality Open Door Forum are...

Note: Rural Open Door Forum addresses provider concerns with physician supervision

  • Medicare Insider, Issue 11, March 16, 2010

    Last Tuesday, March 9, CMS hosted the Rural Health Open Door Forum for rural providers in which...

Transmittals and MLN Matters articles: CMS updates OPPS, implements HIV screening NCD, and more

  • Medicare Insider, Issue 10, March 9, 2010

    On February 26, CMS issued the April 2010 update to the OPPS. The update includes changes to...

Other Issuances: CMS updates FAQs

  • Medicare Insider, Issue 10, March 9, 2010

    CMS posted several new/updated frequently asked questions (FAQ).

CMS Public Events: Rural Health Open Door Forum March 9

  • Medicare Insider, Issue 10, March 9, 2010

    The next Rural Health Open Door Forum is scheduled for Tuesday, March 9, 2010 from 2–3 pm...

Other Issuances: RACs update issues, OIG examines RAC fraud referrals, CMS posts OIVIT NCD

  • Medicare Insider, Issue 9, March 2, 2010

    CGI Federal and Connolly Healthcare, the RACs for regions B and C, continue to update their lists...

CMS Public Events: Open Door Forum March 4

  • Medicare Insider, Issue 9, March 2, 2010

    CMS will host the next Hospital & Hospital Quality Open Door Forum at 2 pm (Eastern) Thursday...

Note: RAC coding reviews and fraud training

  • Medicare Insider, Issue 9, March 2, 2010

    This week several transmittals, including the April quarterly OPPS update, were listed on the...

Note: Recent OIG audits focus on overpayments due to incorrect reporting of drug units

  • Medicare Insider, Issue 8, February 23, 2010

    During the last several months the OIG has been auditing hospital outpatient claims to Medicare for...

CMS Public Events: No events this week

  • Medicare Insider, Issue 5, February 2, 2010

    There are no events this week.

Note: CMS revises "incident to" rules relating to hospital diagnostic services

  • Medicare Insider, Issue 5, February 2, 2010

    During the past several years, CMS has been revising and refining the “incident to&rdquo...

CMS Public Events: Hospital Open Door Forum transcript/recording available

  • Medicare Insider, Issue 4, January 26, 2010

    A transcript and audio recording of the January 14 Hospital & Hospital Quality Open Door Forum...

Note: Changes are on the horizon for critical access hospitals

  • Medicare Insider, Issue 4, January 26, 2010

    In the January 12, 2010 issue of Medicare Weekly Update, we mentioned that CMS had issued a memo...

Transmittals and MLN Matters articles: CMS addresses OIG reports, revises previous transmittals, and more

  • Medicare Insider, Issue 3, January 19, 2010

    On January 15, CMS released a one-time notification detailing various OIG reports that contain...

Other Issuances: RACs update audit issues, CMS posts NCDs, and more

  • Medicare Insider, Issue 2, January 12, 2010

    HealthDataInsights (HDI), the RAC for Region D, and DCS Healthcare, the RAC for Region A, have...

Note: New Medicare Part B Services for 2010 - Pulmonary rehabilitation

  • Medicare Insider, Issue 1, January 5, 2010

    In the OPPS final rule, it was announced that there would be two new services covered under...

Regulations: CMS issues OPPS correction, publishes EHR proposed rule, and more

  • Medicare Insider, Issue 1, January 5, 2010

    On December 31, CMS published in the Federal Register corrections to the previously issued OPPS...

Transmittals and MLN Matters articles: CMS issues MLN Matters articles

  • Medicare Insider, Issue 1, January 5, 2010

    CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare...

MedicareFind update: Diagnostic supervision crosswalk

  • Medicare Insider, Issue 1, January 5, 2010

    MedicareFind subscribers can now access a new Diagnostic Services Physician Supervision Addendum...

Transmittals and MLN Matters articles: CMS issues 2010 lab update, re-issues OPPS update, and more

  • Medicare Insider, Issue 53, December 29, 2009

    On December 21, CMS rescinded and replaced its previous OPPS update transmittal because of an error...

Note: New Medicare Part B Services for 2010

  • Medicare Insider, Issue 53, December 29, 2009

    In the OPPS final rule, it was announced that there would be two new services covered under...

Note: Automatic denial of codes billed with -GA modifier

  • Medicare Insider, Issue 52, December 22, 2009

    Judith previously discussed Transmittal R1840CP implementing a new modifier and instructions for...

Transmittals and MLN Matters articles: CMS implements kidney disease education coverage, replaces transmittals, and more

  • Medicare Insider, Issue 52, December 22, 2009

    On December 18, CMS issued a transmittal to make changes related to the timeframe for contractors...

Other Issuances: RAC issues audit update, CMS clarifies anesthesia guidelines, and more

  • Medicare Insider, Issue 52, December 22, 2009

    On December 18, HealthDataInsights, the RAC for Region D, posted three new issues approved for...

Regulations: CMS corrects MPFS final rule

  • Medicare Insider, Issue 51, December 15, 2009

    On December 10, CMS published a correction in the Federal Register to the Medicare physician fee...

Note: CMS issues manual revisions incorporating CY 2010 OPPS final rule changes

  • Medicare Insider, Issue 51, December 15, 2009

    On Friday, CMS issued two transmittals containing manual provisions that incorporate key changes to...

Transmittals and MLN Matters articles: CMS updates OPPS, issues MLN Matters articles, and more

  • Medicare Insider, Issue 51, December 15, 2009

    On December 11, CMS issued two transmittals to incorporate OPPS updates into the Benefit Policy...

Transmittals and MLN Matters articles: CMS addresses modifier misuse, implements NCD for FDG PET for cervical cancer, and more

  • Medicare Insider, Issue 50, December 8, 2009

    On December 4, CMS issued a transmittal to instruct contractors on the processing of claims that...

Note: CMS provides guidance on voluntary use of ABNs

  • Medicare Insider, Issue 49, December 1, 2009

    In a recent transmittal (R1840CP), CMS provides guidance on the voluntary use of ABNs.  ABNs...

Note: Physician Supervision for Recovery Room and Condition Code 44 Services

  • Medicare Insider, Issue 48, November 24, 2009

    Providers should pay attention to two issues that were quietly discussed in the physician...

Regulations: CMS publishes OPPS final rule

  • Medicare Insider, Issue 48, November 24, 2009

    On November 20, CMS published in the Federal Register the 2010 OPPS final rule. CMS had previously...

Transmittals and MLN Matters articles: CMS issues RAC/ZPIC transmittal, issues MLN Matters articles, and more

  • Medicare Insider, Issue 47, November 17, 2009

    On November 16, CMS issued a transmittal to update the claims processing system to apply the new...

CMS Public Events: Hospital Open Door Forum

  • Medicare Insider, Issue 47, November 17, 2009

    The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday...

Transmittals and MLN Matters articles: CMS updates lab NCD software, issues special edition article, and more

  • Medicare Insider, Issue 46, November 10, 2009

    On November 6th, CMS published an update to the Provider Reimbursement Manual (PRM) with Medicare...

Regulations: CMS extends comment period for proposed ESRD PPS

  • Medicare Insider, Issue 46, November 10, 2009

    On November 4, CMS published a notice in the Federal Register to extend the comment period on its...

Regulations: CMS displays OPPS, MPFS final rules for 2010, and more

  • Medicare Insider, Issue 45, November 3, 2009

    On October 30, CMS released a display copy of the OPPS final rule for CY 2010.

Note: CMS issues 2010 final rule for ambulatory surgery centers and most hospital outpatient departments

  • Medicare Insider, Issue 45, November 3, 2009

    CMS has released a display copy of the outpatient prospective payment system (OPPS) final rule for...

Regulations: CMS announces inpatient hospital deductible and more

  • Medicare Insider, Issue 44, October 27, 2009

    On October 22, CMS published in the Federal Register three notices to announce the inpatient...

Transmittals and MLN Matters articles: CMS updates interest rate, clotting factor fee, and more

  • Medicare Insider, Issue 44, October 27, 2009

    On October 23, CMS issued a transmittal to update the reasonable charge for splints, casts...

CMS Public Events: Hospital & Hospital Quality Open Door Forum

  • Medicare Insider, Issue 41, October 6, 2009

    The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Thursday, October...

Other Issuances: OIG issues 2010 Work Plan, CMS updates lab NCDs, and more

  • Medicare Insider, Issue 41, October 6, 2009

    On October 1, the OIG issued its Work Plan for FY 2010.

Transmittals and MLN Matters articles: CMS updates drug HCPCS hook and hold, rescinds/replaces transmittals, and more

  • Medicare Insider, Issue 40, September 29, 2009

    On September 25, CMS replaced its previous transmittal on LCD exceptions. It had previously sent...

Transmittals and MLN Matters articles: CMS rescinds/replaces transmittals, issues special edition MLN Matters

  • Medicare Insider, Issue 39, September 22, 2009

    On September 18, CMS rescinded and replaced two previous transmittals related to FDG PET coverage.

Note: CMS clarifies RACs' "exception authority"

  • Medicare Insider, Issue 39, September 22, 2009

    On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...

Note: Never Events - Updated guidance on reporting surgical errors for Medicare inpatients

  • Medicare Insider, Issue 38, September 15, 2009

    During the last few years, there has been considerable focus on certain events identified as...

Transmittals and MLN Matters articles: CMS releases MLN Matters articles

  • Medicare Insider, Issue 37, September 8, 2009

    CMS released several MLN Matters articles related to transmittals previously outlined in Medicare...

CMS Public Events: Hospital Open Door Forum transcript, audio available

  • Medicare Insider, Issue 37, September 8, 2009

    The transcript and audio of the August 26 Hospital Open Door Forum (ODF) conference call are now...

Transmittals and MLN Matters articles: CMS issues 5010 instructions, updates OPPS, I/OCE, and moreTransmittals and MLN Matters articles: CMS issues 5010 instructions, updates OPPS, I/OCE, and more

  • Medicare Insider, Issue 36, September 1, 2009

    On August 28, CMS issued transmittal R549OTN, in which it provided instructions to the MACs for...

Note: Condition code 44 - The continuing saga

  • Medicare Insider, Issue 36, September 1, 2009

    On Friday, CMS issued Medicare Claims Processing Manual (MCPM) transmittal 1803, which is the...

CMS Public Events: Hospital Open Door Forum

  • Medicare Insider, Issue 35, August 25, 2009

    The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Wednesday, August...

Note: Inpatient HINNs - Protecting the hospital’s right to recover payment for non-covered services

  • Medicare Insider, Issue 34, August 18, 2009

    Last week, I participated in an HCPro audioconference on HINNs. "HINN" stands for...

Note: CMS announces a coverage determination on the "screening virtual colonoscopy"

  • Medicare Insider, Issue 33, August 11, 2009

    On August 7, CMS issued a transmittal (R105NCD) to implement its decision to maintain non-coverage...

Regulations: IRF PPS published in Federal Register

  • Medicare Insider, Issue 33, August 11, 2009

    On August 7, the inpatient rehabilitation facility prospective payment system (IRF PPS) final rule...

Transmittals and MLN Matters articles: CMS maintains noncoverage of CTC for colorectal cancer and more

  • Medicare Insider, Issue 33, August 11, 2009

    On August 7, CMS issued a transmittal to implement its decision to maintain noncoverage of computed...

Feds arrest dozens nationwide for Medicare fraud scheme

  • Compliance Monitor, Issue 31, August 5, 2009

    Continuing the trend of increased fraud enforcement, the Medicare Fraud Strike Force arrested 32...

Regulations: CMS issues 2010 final rule for IPPS, IRF PPS

  • Medicare Insider, Issue 32, August 4, 2009

    On July 31, CMS issued a display copy of the 2010 IPPS final rule.

Note: Inpatient Prospective Payment System (IPPS) Final Rule Announced

  • Medicare Insider, Issue 32, August 4, 2009

    On July 31, 2009, CMS issued the IPPS final rule announcing the changes that will affect the...

Transmittals and MLN Matters articles: CMS releases MLN Matters articles

  • Medicare Insider, Issue 31, July 28, 2009

    CMS released two MLN Matters article related to transmittals previously outlined in Medicare Weekly...

Other Issuances: CMS posts NCD, OIG issues reports, ICD-9-CM errata available

  • Medicare Insider, Issue 31, July 28, 2009

    On July 21, CMS posted an NCD for sleep testing for OSA.

MedicareFind tip: Zero in on your manual with sub-filters

  • Medicare Insider, Issue 31, July 28, 2009

    CMS’ manual system is an important source of information and guidance — that’s...

Note: Critical access hospitals and billing for non-patient laboratory testing

  • Medicare Insider, Issue 30, July 21, 2009

    In a May 12 post, clarification was given regarding a “non-patient” and reference...

Transmittals and MLN Matters articles: CMS implements NCD, releases MLN Matters article

  • Medicare Insider, Issue 30, July 21, 2009

    On July 17, CMS issued two transmittals to implement its recent NCD for FDG PET for solid tumors...

Regulations: OPPS proposed rule available in Federal Register

  • Medicare Insider, Issue 30, July 21, 2009

    On July 21, CMS published the 2010 OPPS proposed rule in the Federal Register. The proposed rule...

Note: More on condition code 44 and observation

  • Medicare Insider, Issue 29, July 14, 2009

    We have received many questions on the articles we have published on the counting of hours of...

CMS Public Events: ODF conference call this week

  • Medicare Insider, Issue 29, July 14, 2009

    The next Hospital & Hospital Quality Open Door Forum (ODF) conference call is scheduled for...

Transmittals and MLN Matters articles: CMS implements OSA NCD, prepares for lab NCD edit changes, and more

  • Medicare Insider, Issue 29, July 14, 2009

    On July 10, CMS issued a transmittal to update the interest rate for overpayments and underpayments...

Regulations: CMS issues OPPS proposed rule for CY 2010, and more

  • Medicare Insider, Issue 28, July 7, 2009

    On July 1, CMS issued a display copy of the OPPS proposed rule for CY 2010.

Transmittals and MLN Matters articles: CMS re-issues never events transmittals, implements appeals changes

  • Medicare Insider, Issue 28, July 7, 2009

    On July 2, CMS replaced its previous transmittals on the recently issued NCDs for wrong surgery...

Other Issuances: CMS posts NCDs for surgical never events, issues lab NCD update, and more

  • Medicare Insider, Issue 28, July 7, 2009

    On June 29, CMS posted on its Web site the three NCDs for surgical never events.  

Note: 2010 OPPS proposed rule released

  • Medicare Insider, Issue 28, July 7, 2009

    This was a busy week, but the biggest news was the somewhat early release of the OPPS proposed rule...

Note: Inpatient Part B benefit - limited services payable under Part B to hospital inpatients

  • Medicare Insider, Issue 27, June 30, 2009

    Although there were several transmittals and other CMS issuances published during the past week...

Transmittals and MLN Matters articles: CMS re-issues OPPS update, released MLN Matters article for never events NCDs, and more

  • Medicare Insider, Issue 27, June 30, 2009

    On June 26, CMS instructed contractors to make system changes required for implementation of the...

Other Issuances: CMS updates FAQs

  • Medicare Insider, Issue 27, June 30, 2009

    CMS issued several new/updated frequently asked questions (FAQ).

Note: Never Events - CMS issues surgical error NCDs and related guidance

  • Medicare Insider, Issue 25, June 16, 2009

    In 2002, the National Quality Forum (NQF) published a list of 27 events identified as...

Transmittals and MLN Matters articles: CMS implements NCDs for surgical never events, and more

  • Medicare Insider, Issue 25, June 16, 2009

    On June 12, CMS issued updates to the Claims Processing Manual and National Coverage Determinations...

Note: MedicareFind.com launches

  • Medicare Insider, Issue 24, June 10, 2009

    This week, you’ll notice a difference in the Medicare Weekly Update.  I’m pleased...

Transmittals and MLN Matters articles: CMS releases quarterly HCPCS update information, revised guidance on medical record entries, and more

  • Medicare Insider, Issue 24, June 9, 2009

    On June 5, CMS released a transmittal to implement the July 2009 update to HCPCS.

Note: New Modifiers for Outpatient Never Events; Billing for Hospital Acquired Conditions

  • Medicare Insider, Issue 22, May 26, 2009

    This week, CMS published the July Integrated Outpatient Code Editor (I/OCE).  Although there...

Other Issuances: OIG reviews oxaliplatin billing, CMS posts decision memo on CTCs

  • Medicare Insider, Issue 21, May 19, 2009

    On May 14, the OIG issued two reports on oxaliplatin billing. In both cases, the OIG determined...

Note: Clarification of reference (non-patient) laboratory testing

  • Medicare Insider, Issue 20, May 12, 2009

    CMS released Transmittal 1729 to the Claims Processing Manual this week, implementing provisions of...

Note: Proposed FY 2010 IPPS Rule - An overview

  • Medicare Insider, Issue 19, May 5, 2009

    On Friday May 1, CMS released the proposed inpatient prospective payment system (IPPS) rule for FY...

Regulations: CMS issued 2010 IPPS proposed rule, and more

  • Medicare Insider, Issue 19, May 5, 2009

    On May 1, CMS released a display copy of the IPPS proposed rule for fiscal year 2010.

Other Issuances: OIG issues reports on oxaliplatin, E&M, and more

  • Medicare Insider, Issue 19, May 5, 2009

    On April 23, the OIG released a report on outpatient payments for oxaliplatin made in 2004 and 2005...

Q&A: What is an invasive procedure?

  • Compliance Monitor, Issue 17, April 29, 2009

    Q: What is an invasive procedure?

CMS Public Events: Hospital Open Door Forum

  • Medicare Insider, Issue 16, April 21, 2009

    The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for April...

Other Issuances: CMS releases updated lab NCD manual, posts FAQ on MUEs, ABNs

  • Medicare Insider, Issue 16, April 21, 2009

    CMS has posted the April 2009 version of the NCD manual for clinical diagnostic laboratory services...

Note: Medically Unlikely Edits and ABNs

  • Medicare Insider, Issue 16, April 21, 2009

    This was an especially light week for items from CMS for hospitals. This is, perhaps, because...

Note: Compliance with Condition Code 44 - A practical approach

  • Medicare Insider, Issue 15, April 14, 2009

    This week, let’s continue our focus on the so-called Condition Code 44 process. If followed...

Transmittals: CMS lowers interest rate for overpayments and underpayments

  • Medicare Insider, Issue 15, April 14, 2009

    On April 9, CMS lowered the interest rate for Medicare overpayments and underpayments from 11.375...

Other Issuances: OIG issues reviews of high-dollar claims, CMS updates FAQs

  • Medicare Insider, Issue 15, April 14, 2009

    On April 9, the OIG released a review of high-dollar payments for Medicare outpatient claims...

Note: Condition Code 44 - Let's focus on process

  • Medicare Insider, Issue 14, April 7, 2009

    This is the first of two additional Instructor’s Notes that will focus on Condition Code 44...

Other Issuances: CMS posts decision memo, updates FAQs

  • Medicare Insider, Issue 14, April 7, 2009

    On April 3, CMS posted a final decision memo in which it announced revisions to Section 220.6 of...

Note: Observation with condition code 44 and physician supervision

  • Medicare Insider, Issue 13, March 31, 2009

    Last week the American Health Lawyers Association held their annual Institute on Medicare and...

Note: CMS clarifies billing for devices and supplies

  • Medicare Insider, Issue 12, March 24, 2009

    This week, CMS published an MLN Matters article related to the April update to the OPPS published...

Transmittals: CMS revises SOM, issues MLN Matters articles

  • Medicare Insider, Issue 12, March 24, 2009

    On March 20, CMS issued a transmittal to change some portions of the State Operations Manual...

Victory Memorial hospital settles whistleblower case for at least $2.3 million

  • Compliance Monitor, Issue 11, March 18, 2009

    The United States has reached a $2.3 million settlement with Victory Memorial, a not-for-profit...

Note: Hospital compliance with Medicare's post acute transfer rules

  • Medicare Insider, Issue 11, March 17, 2009

    Hospitals are ordinarily entitled to a full DRG payment when patients are discharged to their home...

Transmittals and MLN Matters articles: CMS issues CCI, I/OCE, OPPS updates, and more

  • Medicare Insider, Issue 11, March 17, 2009

    On March 13, CMS issued its quarterly CCI edits update for April.

Other Issuances: OIG issues transfer policy review, CMS issues EMTALA memo

  • Medicare Insider, Issue 11, March 17, 2009

    On March 11, the OIG issued a report in which it determined that hospitals improperly coded 15,051...

Transmittals and MLN Matters articles: CMS updates MPFS, issues MLN Matters articles, and more

  • Medicare Insider, Issue 10, March 10, 2009

    On March 6, CMS issued a transmittal in which it instructed hospitals submit data on their FY 2006...

Other Issuances: CMS issues final decision memo

  • Medicare Insider, Issue 10, March 10, 2009

    On March 3, CMS issued a final decision memo in which it establishes certain conditions of coverage...

Note: Application of critical care Correct Coding Initiative (CCI) edits to hospitals

  • Medicare Insider, Issue 9, March 3, 2009

    Effective January 1, 2009, the CCI edits for evaluation and management (E&M), including...

Transmittals: CMS announces waived tests, releases MLN Matters articles

  • Medicare Insider, Issue 9, March 3, 2009

    On February 27, CMS released a transmittal announcing new waived tests approved by the FDA under...

Other Issuances: CMS releases Heartsbreath NCD

  • Medicare Insider, Issue 9, March 3, 2009

    On February 23, CMS posted an NCD for the Heartsbreath test for heart transplant rejection in which...

Note: Locality adjustment for Medicare Physician Fee Schedule-based payments

  • Medicare Insider, Issue 8, February 24, 2009

    CMS issued Transmittal 1681 February 13, 2009, related to locality adjustment for payments made to...

Other Issuances: CMS updates FAQs, OIG releases audit reports, and more

  • Medicare Insider, Issue 8, February 24, 2009

    CMS released several updated frequently asked questions (FAQ) last week, related to Medicare...

CMS Public Events: Hospital Open Door Forum

  • Medicare Insider, Issue 8, February 24, 2009

    The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...

Q&A: What is HETS?

  • Compliance Monitor, Issue 7, February 18, 2009

    Q: What is HETS? How do I connect to this system?

Transmittals: CMS issues wage index corrections, changes lab NCD edit software, and more

  • Medicare Insider, Issue 7, February 17, 2009

    On February 13, CMS issued clarifying instructions on the calculation of payment amounts for...

Other Issuances: CMS issues proposed, final decision memos, and more

  • Medicare Insider, Issue 7, February 17, 2009

    On February 13, CMS issued a memo in which it clarifies its enforcement approach to certain changes...

Other Issuances: CMS releases NCD for PTA

  • Medicare Insider, Issue 5, February 3, 2009

    On January 26, CMS issued an NCD for PTA in which, consistent with its previously issued decision...

NCDs announced for three 'never events'

  • Healthcare Auditing Weekly, Issue 4, January 27, 2009

    CMS announced national coverage determinations (NCDs) for three preventable errors identified in...

Prepare for approaching ABN deadline

  • Medicare Insider, Issue 4, January 27, 2009

    Medicare has been going through a number of transitions recently. One of these transitions relates...

Regulations: CMS issues OPPS corrections

  • Medicare Insider, Issue 4, January 27, 2009

    On January 26, CMS published in the Federal Register technical corrections to the 2009 OPPS final...

Regulations: ICD-10 final rule published, CMS proposes cytology PT changes

  • Medicare Insider, Issue 3, January 20, 2009

    HHS sets ICD-10-CM/PCS adoption for 2013, CMS proposes changes to cytology proficiency testing (PT...

Other Issuances: CMS finalizes noncoverage of surgical never events

  • Medicare Insider, Issue 3, January 20, 2009

    On January 15, CMS issued national coverage determinations (NCD) finalizing its proposals not to...

Other Issuances: CMS selects final MACs, OIG issues report on high-dollar claims, and more

  • Medicare Insider, Issue 2, January 13, 2009

    On January 8, CMS issued the first results of its Hospital Outpatient Quality Data Reporting...

Where to go to get your laboratory NCD information

  • Medicare Insider, Issue 53, December 30, 2008

    This week, CMS published the laboratory Medicare National Coverage Determinations Coding Policy...

Transmittals: CMS maintains PTA NCD, updates cost report form and instructions

  • Medicare Insider, Issue 53, December 30, 2008

    On December 24, CMS issued a transmittal maintaining its current NCD for PTA of the carotid artery...

Other Issuances: CMS updates lab NCD manual, OIG issues adverse events case study, and more

  • Medicare Insider, Issue 53, December 30, 2008

    CMS has released its January 2009 update to the NCD manual for clinical diagnostic laboratory...

CMS talks quality in listening session

  • Healthcare Auditing Weekly, Issue 48, December 23, 2008

    CMS held a listening session December 18 regarding hospital-acquired conditions (HACs), never...

NP/PA supervision in provider-based departments

  • Medicare Insider, Issue 52, December 23, 2008

    I thought I would do a follow-up to Hugh’s note last week about physician supervision. One of...

Transmittals: CMS announces new waived tests, updates clotting factor furnishing fee, and more

  • Medicare Insider, Issue 52, December 23, 2008

    On December 19, CMS issued its annual update to the furnishing fee for clotting factor.

Other Issuances: CMS updates serum iron studies NCD, OIG publishes safe harbor notice, and more

  • Medicare Insider, Issue 52, December 23, 2008

    On December 18, CMS extended coverage under the serum iron studies NCD to ICD-9-CM codes 285.22 and...

Nurse sentenced for Medicare fraud

  • Compliance Monitor, Issue 90, December 17, 2008

    Marie Weller King, registered nurse and owner of King and Associates, will serve 18 months in...

Physician supervision for on-campus provider-based departments

  • Medicare Insider, Issue 51, December 16, 2008

    A colleague (another healthcare lawyer) contacted me last week to talk about CMS’s discussion...

Transmittals: CMS rejects TIPs coverage, implements changes to medical necessity edits for lab services

  • Medicare Insider, Issue 51, December 16, 2008

    On December 12, CMS updated its Program Integrity Manual to reflect recent changes to its...

Other Issuances: CMS updates frequently asked questions, issues decision memo; OIG issues reports

  • Medicare Insider, Issue 51, December 16, 2008

    On December 12, CMS issued 125 new/updated frequently asked questions related to Medicare...

Regulations: CMS publishes revised final wage indices and hospital reclassifications

  • Medicare Insider, Issue 50, December 9, 2008

    On December 3, CMS published in the Federal Register revised final wage indices and hospital...

Other Issuances: CMS proposes NCDs for surgical never events, OIG issues Semiannual Report, and more

  • Medicare Insider, Issue 50, December 9, 2008

    On December 3, the OIG issued its Semiannual Report to Congress for April 1–September 30 of...

CMS Public Events: HAC listening session

  • Medicare Insider, Issue 50, December 9, 2008

    CMS has scheduled a listening session on hospital-acquired conditions (HAC) in inpatient and...

Strategies for Health Care Compliance December 2008

  • Strategies for Health Care Compliance, Issue 12, December 1, 2008

    Inside: Examine short stays, avoid overpayment Direct-to-consumer genetic testing is a state...

Imaging accreditation will be mandatory in 2012

  • Strategies for Health Care Compliance, Issue 12, December 1, 2008

    Your imaging facility is on the clock. The Medicare Improvements for Patients and Providers Act of...

OIG finds billions in inappropriate DSH payments

  • Healthcare Auditing Weekly, Issue 42, November 11, 2008

    In a review of Medicare capital disproportionate share hospital (DSH) payments, the OIG found that...

Regulations: No issuances this week

  • Medicare Insider, Issue 45, November 11, 2008

    CMS issued no significant regulations affecting hospital billing this week.

Transmittals: CMS issues HCPCS update, updates therapy code list, and more

  • Medicare Insider, Issue 45, November 11, 2008

    On November 7, CMS issued a transmittal implementing an update to HCPCS for 2009.

CMS Public Events: ODF call scheduled for November 17

  • Medicare Insider, Issue 45, November 11, 2008

    The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...

CMS releases display copy of CY 2009 MPFS, seeks comments on Stark exception

  • Compliance Monitor, Issue 84, November 5, 2008

    CMS releases display copy of CY 2009 MPFS, seeks comments on Stark exception

Other Issuances: OIG issues review of HIPAA security enforcement, reports on high-dollar payments

  • Medicare Insider, Issue 44, November 4, 2008

    On October 30, the OIG issued a review of CMS’ oversight of the HIPAA security rule. The OIG...

CMS Public Events

  • Medicare Insider, Issue 44, November 4, 2008

    CMS has no public events scheduled for this week.

Are hospitals improperly converting inpatient cases to observation?

  • Medicare Insider, Issue 43, October 28, 2008

    It was recently brought to my attention that some (perhaps many) hospitals may be using the...

Regulations: No issuances this week

  • Medicare Insider, Issue 43, October 28, 2008

    CMS issued no significant regulations affecting hospital billing this week.

Transmittals: CMS implements CWF edits, changes interpretive guidelines for hospital conditions of participation, and more

  • Medicare Insider, Issue 43, October 28, 2008

    On October 24, CMS issued a transmittal recognizing four authoritative compendia for use in...

CMS Public Events

  • Medicare Insider, Issue 43, October 28, 2008

    CMS has no public events scheduled for this week.

Watch for potential RAC trickle-down effect

  • Medicare Insider, Issue 42, October 21, 2008

    I taught a Medicare course in Chicago last week. One of the course participants from California...

Transmittals: CMS updates interest rate for Medicare overpayments and underpayments, clarifies previous transmittal on CPAP therapy for OSA

  • Medicare Insider, Issue 42, October 21, 2008

    On October 15, CMS issued a transmittal instructing Medicare contractors to implement an interest...

Other Issuances: CMS issues decision memo on PTA, OIG reviews high-dollar payments

  • Medicare Insider, Issue 42, October 21, 2008

    On October 16, the OIG issued a report on high-dollar payments for inpatient and outpatient claims...

CMS Public Events

  • Medicare Insider, Issue 42, October 21, 2008

    CMS has no public events scheduled for this week.

MLN Matters articles: CMS issues articles on lab NCD edits, FY 2009 IPPS changes

  • Medicare Insider, Issue 41, October 14, 2008

    CMS released two MLN Matters articles last week related to transmittals previously announced in...

CMS Public Events

  • Medicare Insider, Issue 41, October 14, 2008

    CMS has no public events scheduled for this week.

Tip: Guidelines for documenting screening treatment

  • Compliance Monitor, Issue 78, October 8, 2008

    Tip: Guidelines for documenting screening treatment

Busy week: OIG Work Plan, CMS' MUE list available

  • Medicare Insider, Issue 40, October 7, 2008

    There were a number of significant regulatory developments last week, including the release of the...

Regulations: CMS issues wage indices, payment rates, and corrections for 2009 IPPS

  • Medicare Insider, Issue 40, October 7, 2008

    On October 3, CMS published in the Federal Register a notice providing the wage indices, hospital...

Transmittals and MLN Matters articles: CMS updates IPPS, lab NCDs, and more

  • Medicare Insider, Issue 40, October 7, 2008

    On October 3, CMS issued a transmittal implementing FY 2009 changes for IPPS hospitals. The...

Other Issuances: CMS publishes MUEs, OIG issues annual Work Plan, and more

  • Medicare Insider, Issue 40, October 7, 2008

    On October 3, the OIG released a report on high-dollar payments that National Government Services...

CMS Public Events: ODF scheduled for October 9

  • Medicare Insider, Issue 40, October 7, 2008

    The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...

MLN Matters articles: CMS releases articles on OPPS, OCE updates

  • Medicare Insider, Issue 39, September 30, 2008

    CMS released two MLN Matters articles last week related to transmittals previously announced in...

Other Issuances: CMS revises heart-related NCDs, announces 2009 deductible and coinsurance amounts

  • Medicare Insider, Issue 39, September 30, 2008

    On September 26, CMS issued two revised NCDs, one for heart transplants and one for artificial...

CMS Public Events

  • Medicare Insider, Issue 39, September 30, 2008

    CMS has no public events scheduled for this week.

Medicare Part B premiums remain the same in 2009

  • Healthcare Auditing Weekly, Issue 36, September 23, 2008

    CMS recently announced its premiums and deductibles for 2009 in a press release on the CMS Web site.

Transmittals and MLN Matters articles: CMS issues OPPS, NCCI updates, and more

  • Medicare Insider, Issue 38, September 23, 2008

    On September 19, CMS released the fourth quarter update to the NCCI edits.

Other Issuances: OIG issues report on high-dollar payments

  • Medicare Insider, Issue 38, September 23, 2008

    On September 15, the OIG issued a report on high-dollar payments for inpatient services processed...

CMS Public Events

  • Medicare Insider, Issue 38, September 23, 2008

    CMS has no public events scheduled for this week.

Regulations: CMS publishes IRF PPS correction

  • Medicare Insider, Issue 37, September 16, 2008

    On September 12, CMS published in the Federal Register a correction to the IRF PPS. The correction...

Transmittals and MLN Matters articles: CMS updates OCE, ASP drug pricing files, and more

  • Medicare Insider, Issue 37, September 16, 2008

    On September 12, CMS rescinded its May 20, 2008, transmittal (Change Request 6012) regarding the...

CMS Public Events

  • Medicare Insider, Issue 37, September 16, 2008

    CMS has no public events scheduled for this week.

Transmittals and MLN Matters articles: CMS issues revised ABN instructions, physician signature article, and more

  • Medicare Insider, Issue 36, September 9, 2008

    On September 5, CMS released revised manual instructions on limitation on liability, including use...

CMS Public Events

  • Medicare Insider, Issue 36, September 9, 2008

    CMS has no public events scheduled for this week.

CMS issues transmittal on physician signature requirements

  • Medicare Insider, Issue 35, September 3, 2008

    As reported below, CMS issued a transmittal last week (Change Request 6100) updating Section 80.6.1...

Transmittals: CMS implements artificial heart NCD, clarifies physician signature requirements, and more

  • Medicare Insider, Issue 35, September 3, 2008

    On August 29, CMS issued two transmittals implementing its May 1 NCD that established coverage for...

CMS Public Events

  • Medicare Insider, Issue 35, September 3, 2008

    CMS has no public events scheduled for this week.