Corporate Compliance Articles by Topic: Medicare Coverage and Reimbursement
-
Medicare Insider, Issue 12, March 26, 2013
The Medicare Audit Improvement Act, which aims to rectify problems identified in the Recovery...
-
Medicare Insider, Issue 12, March 26, 2013
Highlights of the past week’s Medicare updates include the accompanying transmittal for the...
-
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...
-
Medicare Insider, Issue 11, March 19, 2013
Performant Recovery posted four new issues across three categories, Connolly posted a new issue for...
-
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...
-
Medicare Insider, Issue 11, March 19, 2013
Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed...
-
Medicare Insider, Issue 49, December 4, 2012
CMS issues press release on prescription drug cost savings
-
Medicare Insider, Issue 49, December 4, 2012
CMS issues therapy cap values for CY 2013
-
Medicare Insider, Issue 49, December 4, 2012
CMS issues draft notice of Benefit and Payment Parameters for 2014
-
Medicare Insider, Issue 49, December 4, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 48, November 27, 2012
CMS issues notice on hospital outpatient payment panel
-
Medicare Insider, Issue 47, November 20, 2012
CMS issues 2013 OPPS final rule in Federal Register
-
Medicare Insider, Issue 47, November 20, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 47, November 20, 2012
CMS issues transmittal on testing HIPAA transactions following a system change
-
Medicare Insider, Issue 47, November 20, 2012
Other issuances: OIG issues reviews of Medicare appeals at the administrative law judge level in...
-
Medicare Insider, Issue 46, November 13, 2012
Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles
-
Medicare Insider, Issue 46, November 13, 2012
CMS issues technology assessment on electronic cardiac devices
-
Medicare Insider, Issue 45, November 6, 2012
CMS issues nursing home clarification letter
-
Medicare Insider, Issue 45, November 6, 2012
CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs
-
Medicare Insider, Issue 45, November 6, 2012
CMS issues 2013 OPPS final rule
-
Medicare Insider, Issue 45, November 6, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 44, October 30, 2012
CMS issues corrections to 2013 IPPS final rule
-
Medicare Insider, Issue 44, October 30, 2012
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...
-
Medicare Insider, Issue 43, October 23, 2012
CMS issues details on evidentiary characteristics for CED MEDCAC meeting
-
Medicare Insider, Issue 43, October 23, 2012
CMS updates chapter 7, Medicare Financial Management Manual
-
Medicare Insider, Issue 43, October 23, 2012
CMS issues correcting amendment to 2013 IPPS final rule
-
Medicare Update for CAHs, Issue 21, October 17, 2012
Earlier this year, CMS held its first Hospital Outpatient Payment Panel meeting, which managed to...
-
Medicare Insider, Issue 42, October 16, 2012
CMS issues press release on 2013 quality ratings for Medicare health and drug plans
-
Medicare Insider, Issue 42, October 16, 2012
CMS issues notice of new interest rate for Medicare overpayments and underpayments
-
Medicare Insider, Issue 42, October 16, 2012
Editor’s note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is...
-
Medicare Insider, Issue 41, October 9, 2012
CMS issues corrections to administrative simplification final rule
-
Medicare Insider, Issue 41, October 9, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 41, October 9, 2012
CMS issues new waived tests
-
Medicare Insider, Issue 40, October 2, 2012
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...
-
Medicare Insider, Issue 40, October 2, 2012
CMS replaces transmittal on manual medical review of therapy services
-
Medicare Insider, Issue 40, October 2, 2012
Other issuances: CMS issues preliminary decisions on recommendations of outpatient payment panel on...
-
Medicare Insider, Issue 39, September 25, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 39, September 25, 2012
CMS issues transmittal on ICD-10 conversions from ICD-9
-
Medicare Insider, Issue 39, September 25, 2012
CMS issues press release on Medicare Advantage
-
Medicare Insider, Issue 38, September 18, 2012
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...
-
Medicare Insider, Issue 38, September 18, 2012
CMS issues training series for nursing homes
-
Medicare Insider, Issue 38, September 18, 2012
OIG issues review of inpatient rehabilitation facility claims with late patient assessment...
-
Medicare Insider, Issue 37, September 11, 2012
CMS issues technology assessment on ECG-based analysis technologies
-
Medicare Insider, Issue 37, September 11, 2012
CMS issues transmittal on expiration of 2012 therapy cap revisions and user-controlled mechanism to...
-
Medicare Insider, Issue 37, September 11, 2012
CMS issues administrative simplification final rule
-
Medicare Insider, Issue 37, September 11, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 34, August 21, 2012
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...
-
Medicare Insider, Issue 34, August 21, 2012
CMS updates inpatient psychiatric facilities PPS for FY 2013
-
Medicare Insider, Issue 34, August 21, 2012
OIG issues report on leuprolide acetate injections in Ohio
-
Medicare Insider, Issue 34, August 21, 2012
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
-
Medicare Insider, Issue 33, August 14, 2012
CMS issues NCD for TAVR (20.32)
-
Medicare Insider, Issue 33, August 14, 2012
CMS issues interim final rule for adoption of operating rules for healthcare EFT and RA transactions
-
Medicare Insider, Issue 33, August 14, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 32, August 7, 2012
CMS will hold a special open door forum on the Medicare fee-for-service Recovery Auditor prepayment...
-
Medicare Insider, Issue 32, August 7, 2012
CMS issues an NCA for autologous blood-derived products for chronic non-healing wounds (CAG-00190R3)
-
Medicare Insider, Issue 32, August 7, 2012
CMS issues directions to modify institutional reason code 39012
-
Medicare Insider, Issue 32, August 7, 2012
On August 1, CMS issued a display copy of the 2013 inpatient prospective payment system 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...
-
Medicare Insider, Issue 31, July 31, 2012
Obama administration announces public-private partnership to prevent healthcare fraud
-
Medicare Insider, Issue 31, July 31, 2012
CMS issues new waived tests
-
Medicare Insider, Issue 31, July 31, 2012
CMS issues 2013 OPPS proposed rule
-
Medicare Insider, Issue 31, July 31, 2012
Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...
-
Medicare Insider, Issue 28, July 10, 2012
CMS issues three-day payment window FAQs
-
Medicare Insider, Issue 28, July 10, 2012
CMS replaces transmittal on reporting of recoupment for overpayment on the RA
-
Medicare Insider, Issue 28, July 10, 2012
CMS issues 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...
-
Medicare Insider, Issue 27, July 3, 2012
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...
-
Medicare Insider, Issue 27, July 3, 2012
CMS replaces transmittal on October quarterly update HCPCS codes used for SNF CB enforcement
-
Medicare Insider, Issue 27, July 3, 2012
CMS issues press release on healthcare law
-
Medicare Insider, Issue 26, June 26, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 26, June 26, 2012
CMS issues transmittal on provider self audits
-
Medicare Insider, Issue 26, June 26, 2012
CMS issues an NCA for liver transplantation for malignancies
-
Medicare Insider, Issue 25, June 19, 2012
CMS posts IPPS proposed and final rules, relevant correction notices for FY 2013
-
Medicare Insider, Issue 25, June 19, 2012
CMS issues transmittal on process for handling esMD
-
Medicare Insider, Issue 25, June 19, 2012
CMS issues July 2012 NCD Coding Policy Manual and Change Report
-
Medicare Insider, Issue 24, June 12, 2012
Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...
-
Medicare Update for Physician Services, Issue 6, June 7, 2012
Were you ever curious about the difference between the National Provider Identifier (NPI) versus...
-
Medicare Insider, Issue 23, June 5, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 22, May 29, 2012
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...
-
Medicare Insider, Issue 22, May 29, 2012
CMS replaces transmittal on screening for STIs and HIBC to prevent STIs (ICD-10)
-
Medicare Insider, Issue 22, May 29, 2012
CMS instructs on use of insulin pens in healthcare facilities
-
Medicare Insider, Issue 21, May 22, 2012
CMS issues general update to chapter 15 of the PIM – Part VI
-
Medicare Insider, Issue 21, May 22, 2012
CMS posts rules to cut regulations for hospitals and providers
-
Medicare Insider, Issue 20, May 15, 2012
OIG issues compliance re view of Missouri hospital
-
Medicare Insider, Issue 20, May 15, 2012
CMS instructs on implementation of fraud prevention predictive modeling prepayment edits and more
-
Medicare Insider, Issue 20, May 15, 2012
CMS releases 2013 IPPS proposed rule, finalizes rules to cut regulations for hospitals and...
-
Medicare Insider, Issue 20, May 15, 2012
Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...
-
Medicare Insider, Issue 19, May 8, 2012
On May 3, the OIG issued a review of outpatient brachytherapy Medicare payments at Lakewood Rance...
-
Medicare Insider, Issue 19, May 8, 2012
On April 27, CMS issued a transmittal that extends the therapy cap exceptions process through...
-
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...
-
Medicare Insider, Issue 19, May 8, 2012
In a recent transmittal, CMS issued guidance on Congress’ extension of limitations on certain...
-
Medicare Update for Physician Services, Issue 5, May 3, 2012
CMS issues final rule on provider and supplier enrollment, ordering and referring, and...
-
Medicare Update for Physician Services, Issue 5, May 3, 2012
CMS revises "incident to" transmittal
-
Medicare Update for Physician Services, Issue 5, May 3, 2012
CMS updates Part B drug pricing files
-
Medicare Update for Physician Services, Issue 5, May 3, 2012
OIG issues review of Medicare outpatient billing for selected drugs at Catskill Regional Medical...
-
Medicare Insider, Issue 18, May 1, 2012
OIG issues report on Southern Calif. Renal Disease Council inc. billing compliance
-
Medicare Insider, Issue 18, May 1, 2012
CMS issues guidance on overpayment recovery from DMEPOS suppliers
-
Medicare Insider, Issue 18, May 1, 2012
CMS issues IPPS proposed rule for FY2013
-
Medicare Insider, Issue 18, May 1, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
-
Medicare Insider, Issue 17, April 24, 2012
OIG issues Medicare compliance review of D.C. hospital
-
Medicare Insider, Issue 17, April 24, 2012
MLN Matters articles
-
Medicare Insider, Issue 17, April 24, 2012
HHS issues administrative simplification proposed rule
-
Medicare Insider, Issue 17, April 24, 2012
Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...
-
Medicare Insider, Issue 38, September 20, 2011
CMS provides updates on a quarterly basis during the calendar year to reflect changes to, and...
-
Medicare Update for Physician Services, Issue 9, September 2, 2011
MedicareFind subscribers can now access the written transcript and audio recording of the...
-
Medicare Update for Physician Services, Issue 9, September 1, 2011
CMS has posted its regular update transmittal for HCPCS Level II codes.
-
Medicare Insider, Issue 33, August 16, 2011
On August 12, CMS issued a transmittal to give instructions regarding the medically unlikely edits...
-
Medicare Insider, Issue 32, August 9, 2011
On July 29, CMS issued a transmittal to shift responsibility for issuance of demand letters from...
-
Medicare Insider, Issue 32, August 9, 2011
The FY2012 IPPS final rule was put on display this week. The rule contained some...
-
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...
-
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...
-
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...
-
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...
-
Medicare Insider, Issue 29, July 19, 2011
On July 15, CMS issued a transmittal to make quarterly updates to the end-stage renal disease...
-
Medicare Insider, Issue 29, July 19, 2011
In 2011, the AMA introduced three new CPT codes for computed tomography (CT) of the abdomen and...
-
Medicare Insider, Issue 28, July 12, 2011
CMS has posted a new version of the lab NCD manual for the third quarter.
-
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.
-
Medicare Insider, Issue 28, July 12, 2011
CMS released the OPPS proposed rule almost one month earlier than we usually see it. CMS...
-
Medicare Update for Physician Services, Issue 7, July 7, 2011
CMS released a special edition MLN Matters article regarding foot care coverage guidelines. ...
-
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.
-
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.
-
Medicare Insider, Issue 26, June 28, 2011
CMS released two special edition MLN articles this week. One article, SE1121, highlights some...
-
Medicare Insider, Issue 26, June 28, 2011
CMS has issued a special MLN Matters article on DRG coding vulnerabilities for inpatient...
-
Medicare Insider, Issue 25, June 21, 2011
CMS has posted a new set of FAQs on the initial preventive physical examination (IPPE).
-
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...
-
Medicare Insider, Issue 24, June 14, 2011
Last February, I wrote about the proposed rule for Medicaid health care-acquired conditions (HCACs...
-
Medicare Insider, Issue 23, June 7, 2011
On June 1, CMS released a rule to finalize a payment adjustment for provider-preventable...
-
Medicare Insider, Issue 23, June 7, 2011
CMS has issued its regular updates to the OPPS for July. The update includes information on new...
-
Medicare Insider, Issue 23, June 7, 2011
This week CMS released a special edition MLN Matters article reviewing the coverage of...
-
Medicare Update for Physician Services, Issue 6, June 2, 2011
MedicareFind subscribers can now access a transcript and recording of the April 5 Physicians...
-
Medicare Update for Physician Services, Issue 6, June 2, 2011
CMS has posted the RVU quarterly update file under the MPFS.
-
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...
-
Medicare Insider, Issue 22, May 31, 2011
In an effort to provide quality healthcare to beneficiaries enrolled in original Medicare (Medicare...
-
Medicare Insider, Issue 22, May 31, 2011
On May 20, CMS issued a transmittal to provide further clarification regarding certified...
-
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...
-
Medicare Insider, Issue 21, May 24, 2011
On May 16, the OIG issued a report on CMS’ oversight and enforcement of HIPAA. The OIG...
-
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...
-
Medicare Insider, Issue 20, May 17, 2011
On May 13, CMS issued a transmittal to clarify policy with respect to restrictions on pharmacy...
-
Medicare Insider, Issue 20, May 17, 2011
High dose brachytherapy is not listed as an inpatient procedure but requires a patient to remain...
-
Medicare Insider, Issue 19, May 10, 2011
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...
-
Medicare Insider, Issue 19, May 10, 2011
Last week, I addressed one of the clarifications that CMS had announced in the FY 2012 IPPS...
-
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...
-
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...
-
Medicare Insider, Issue 18, May 3, 2011
CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare...
-
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...
-
Compliance Monitor, Issue 17, April 27, 2011
Two Miami-area medical assistants and a physician assistant will serve time in prison for their...
-
Compliance Monitor, Issue 17, April 27, 2011
Cardinal Health Inc. agreed to pay $8 million to resolve claims that it violated the False Claims...
-
Medicare Insider, Issue 17, April 26, 2011
CMS has issued for public inspection a proposed rule to make changes to the inpatient prospective...
-
Compliance Monitor, Issue 16, April 20, 2011
Two Miami-area residents and owners of a mental healthcare corporation pleaded guilty to submitting...
-
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...
-
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...
-
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...
-
Medicare Update for Physician Services, Issue 4, April 7, 2011
MedicareFind subscribers can now access the transcript and audio of the Physicians, Nurses, and...
-
Medicare Update for Physician Services, Issue 4, April 7, 2011
CMS’ physician regulatory issues team (PRIT) recently addressed the question of whether a...
-
Medicare Update for Physician Services, Issue 4, April 7, 2011
CMS has posted an update to the clinical laboratory fee schedule (CLFS) file.
-
Compliance Monitor, Issue 14, April 6, 2011
CMS has issued MLN Matters Article MM7350 to explain how the new provider enrollment provisions...
-
Medicare Insider, Issue 14, April 5, 2011
My colleague, Judith Kares, wrote about the new CPT guidance on critical care for 2011 and the...
-
Compliance Monitor, Issue 13, March 30, 2011
The Greater Palm Beach Health Care Fraud Task Force arrested Selwyn Carrington, MD, 57, of Miami...
-
Medicare Insider, Issue 13, March 29, 2011
On March 23, CMS published in the Federal Register a notice to announce the
$505 calendar year...
-
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...
-
Medicare Insider, Issue 13, March 29, 2011
CMS has released the most recent version of its lab NCD manual.
-
Medicare Insider, Issue 13, March 29, 2011
There are no public events this week.
-
Medicare Insider, Issue 13, March 29, 2011
Those of us who have wondered what the outcome will be of CMS’ three-month delay in...
-
Case Management Weekly, Issue 12, March 23, 2011
Medical necessity acquires new meaning in the context of recent MAC, RAC, and CERT denials of...
-
Medicare Insider, Issue 12, March 22, 2011
On March 18, CMS issued a transmittal to make quarterly updates to the OPPS for April. The...
-
Medicare Insider, Issue 11, March 15, 2011
CMS has released a special edition MLN Matters article on place-of-service coding in response to...
-
Medicare Insider, Issue 11, March 15, 2011
After having discussions with the Medicare Specialist and Nurse Auditor at my facility, I was...
-
Medicare Insider, Issue 11, March 15, 2011
On March 11, CMS published in the Federal Register corrections to the 2011 OPPS final rule.
-
Medicare Insider, Issue 11, March 15, 2011
In a recent MLN Matters article, Medicare once again reminded physicians and their billing agents...
-
Compliance Monitor, Issue 10, March 9, 2011
Senator Chuck Grassley introduced legislation to build on key reforms to fight fraud in Medicare...
-
Compliance Monitor, Issue 10, March 9, 2011
One crucial element of a good compliance program is having a supportive board and senior management.
-
Medicare Insider, Issue 10, March 8, 2011
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 10, March 8, 2011
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...
-
Medicare Insider, Issue 10, March 8, 2011
This week I thought I’d take the opportunity to address a confusing coding issue related to...
-
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...
-
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...
-
Medicare Update for Physician Services, Issue 3, March 3, 2011
CMS has issued its second edition of its provider compliance newsletter. This issue features...
-
Medicare Update for Physician Services, Issue 3, March 3, 2011
While advance beneficiary notices (ABN) have been simplified with the implementation of the...
-
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...
-
Compliance Monitor, Issue 9, March 2, 2011
Q: What is esMD and how can my hospital sign up?
-
Medicare Insider, Issue 9, March 1, 2011
In two recent transmittals (and a related MLN Matters article) Medicare clarified its new benefit...
-
Medicare Insider, Issue 9, March 1, 2011
CMS posted a letter to delay the timeline for implementation of the Medicaid RACs. States will not...
-
Medicare Insider, Issue 9, March 1, 2011
On February 25, CMS issued a transmittal to instruct its auditing contractors (e.g., RAC, CERT...
-
Compliance Monitor, Issue 8, February 23, 2011
The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged...
-
Medicare Insider, Issue 8, February 22, 2011
How should we bill Medicare for clia waived tests in a provider based clinic? Should it be...
-
Compliance Monitor, Issue 7, February 16, 2011
St. Joseph’s/Candler Health System (SJCHS) agreed to pay $2.7million to settle allegations...
-
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...
-
Medicare Insider, Issue 7, February 15, 2011
CMS rescinded and replaced a transmittal previously outlined in Medicare Weekly Update.
-
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...
-
Medicare Insider, Issue 6, February 8, 2011
Neither CMS nor the OIG released any other significant issuances this week affecting coverage...
-
Medicare Insider, Issue 6, February 8, 2011
There are no public events this week.
-
Medicare Insider, Issue 6, February 8, 2011
In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs, PSCs...
-
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...
-
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...
-
Medicare Update for Physician Services, Issue 1, February 3, 2011
MedicareFind subscribers can now access the transcript and audio of the Physicians, Nurses and...
-
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...
-
Medicare Insider, Issue 5, February 1, 2011
CMS has clarified that outpatient procedures that meet preadmission packaging requirements and...
-
Medicare Insider, Issue 5, February 1, 2011
On January 14, CMS issued a memorandum to state survey directors to further clarify requirements...
-
Medicare Insider, Issue 5, February 1, 2011
CMS has posted a special edition MLN Matters article on inpatient admission decisions and the use...
-
Medicare Insider, Issue 5, February 1, 2011
CMS has issued a display copy of a final rule to implement provisions of the Patient Protection...
-
Medicare Insider, Issue 4, January 25, 2011
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...
-
Medicare Insider, Issue 4, January 25, 2011
What diagnosis code should be used with the G0438 procedure code?
-
Medicare Insider, Issue 4, January 25, 2011
On January 21, CMS issued a transmittal to update its manual system with changes to the timely...
-
Medicare Insider, Issue 4, January 25, 2011
Critical access hospitals (CAHs) are hospitals that have met very specific requirements &ndash...
-
Compliance Monitor, Issue 3, January 19, 2011
Every month, Compliance Monitor provides a sneak peek at the upcoming issue of Briefings on Coding...
-
Compliance Monitor, Issue 3, January 19, 2011
Renier Vicente Rodriguez Fleitas, 60, of Miami-Dade County, will serve 37 months after pleading...
-
Medicare Insider, Issue 3, January 18, 2011
As part of its continuing efforts to forge a closer link between Medicare’s payment systems...
-
Medicare Insider, Issue 3, January 18, 2011
On January 13, CMS published in the Federal Register a proposed rule that would establish a...
-
Medicare Insider, Issue 2, January 11, 2011
On January 7, CMS issued a display copy of a proposed rule that would establish a hospital...
-
Medicare Insider, Issue 2, January 11, 2011
On December 30, CMS issued two transmittals to implement updates to the OPPS for 2011. Changes...
-
Medicare Insider, Issue 2, January 11, 2011
As you are aware, the most significant changes to the Medicare rules that apply to outpatient...
-
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...
-
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...
-
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.
-
Medicare Update for Physician Services, Issue 1, January 6, 2011
The next Physician, Nurses and Allied Health Professionals Open Door Forum is scheduled for...
-
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...
-
Compliance Monitor, Issue 1, January 5, 2011
Q: How should providers prepare for Medicaid RACs?
-
Medicare Insider, Issue 1, January 4, 2011
On December 30, CMS issued a transmittal to implement a new hospital cost report (CMS-2552-10...
-
Medicare Insider, Issue 1, January 4, 2011
CMS has issued the lab NCD manual for the first quarter of 2011.
-
Medicare Insider, Issue 1, January 4, 2011
I hope you had a wonderful holiday and started the new year in style! Things were pretty...
-
Medicare Insider, Issue 52, December 28, 2010
CMS announced the availability of registration for the Medicare electronic health record (EHR...
-
Medicare Insider, Issue 52, December 28, 2010
CMS replaces transmittals, issues MLN Matters article
-
Compliance Monitor, Issue 48, December 22, 2010
CMS is looking to acquire new state-of-the-art fraud fighting tools to prevent wasteful and...
-
Compliance Monitor, Issue 48, December 22, 2010
Alan Silber, MD, will serve 36 months in prison for participating in a scheme to defraud the...
-
Medicare Insider, Issue 51, December 21, 2010
TMF announced several updates to the Program for Evaluating Payment Patterns Electronic Report...
-
Medicare Insider, Issue 51, December 21, 2010
Last week, it was announced that critical access hospitals (CAHs) will be able to add a little...
-
Compliance Monitor, Issue 47, December 15, 2010
Kos Pharmaceuticals agreed to pay more than $41 million to resolve claims that it offered illegal...
-
Medicare Insider, Issue 50, December 14, 2010
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 50, December 14, 2010
Last Friday, CMS issued transmittal R361PI requiring mandatory advanced beneficiary notices (ABNs...
-
Medicare Insider, Issue 50, December 14, 2010
On December 10, CMS issued a transmittal to require that medical reviewers request all a mandatory...
-
Medicare Insider, Issue 49, December 7, 2010
This week CMS released 2 transmittals implementing the Annual Wellness Visit (AWV), including...
-
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...
-
Medicare Update for Physician Services, Issue 12, December 2, 2010
The transcript and audio recording of the November 16 Physicians, Nurses, and Allied Health...
-
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...
-
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...
-
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...
-
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...
-
Compliance Monitor, Issue 45, December 1, 2010
The Department of Justice (DOJ) recovered $2.5 billion in healthcare fraud recoveries for fiscal...
-
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...
-
Medicare Insider, Issue 48, November 30, 2010
On November 24, CMS issued a transmittal to provide instructions for the CY 2011 clinical...
-
Medicare Insider, Issue 48, November 30, 2010
On November 19, the OIG issued a review of UMass Memorial Medical Center claims for outpatient...
-
Medicare Insider, Issue 48, November 30, 2010
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 48, November 30, 2010
Discussions regarding signature requirements for laboratory services have been going on for the...
-
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...
-
Medicare Insider, Issue 47, November 23, 2010
This week, CMS published the transmittal with new manual sections implementing the new deductibles...
-
Medicare Insider, Issue 47, November 23, 2010
On November 19, CMS issued a transmittal to implement new HCPCS Q codes for 2010-2011 seasonal...
-
Medicare Insider, Issue 46, November 16, 2010
On November 9, CMS published three notices in the Federal Register to set various premium...
-
Medicare Insider, Issue 46, November 16, 2010
On November 12, CMS issued a transmittal to expand the current IPPS transfer policy. Currently, a...
-
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...
-
Compliance Monitor, Issue 42, November 10, 2010
Simi Valley (CA) Hospital paid the United States $5.1 million to resolve allegations that its...
-
Medicare Insider, Issue 45, November 9, 2010
On November 5, CMS posted a proposed rule regarding the RAC expansion into Medicaid. The rule...
-
Medicare Insider, Issue 45, November 9, 2010
On October 29, CMS issued a transmittal to instruct contractors that, for discharges on or after...
-
Medicare Insider, Issue 45, November 9, 2010
There are no public events this week.
-
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...
-
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...
-
Medicare Update for Physician Services, Issue 11, November 4, 2010
On October 22, CMS issued a transmittal to provide updated payment allowances for seasonal...
-
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.
-
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...
-
Medicare Update for Physician Services, Issue 11, November 4, 2010
The next Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for...
-
Compliance Monitor, Issue 41, November 3, 2010
The Christ Hospital (TCH) of Cincinnati, OH, and the Office of Inspector General (OIG) entered into...
-
Medicare Insider, Issue 44, November 2, 2010
On October 29, CMS issued a transmittal to provide guidance on the three-day payment window, as...
-
Medicare Insider, Issue 44, November 2, 2010
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 44, November 2, 2010
Neither CMS nor the OIG released any other significant issuances this week affecting coverage...
-
Medicare Insider, Issue 44, November 2, 2010
Weigh in on a recent MedicareFind Forum question:
Are paper EOMBs required under Medicare?
Read...
-
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...
-
Medicare Insider, Issue 43, October 26, 2010
On October 18, CMS issued a transmittal to instruct contractors to implement an interest rate of...
-
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...
-
Medicare Insider, Issue 42, October 19, 2010
On October 15, CMS issued a one-time notification to implement new revenue codes created by the...
-
Medicare Insider, Issue 41, October 12, 2010
On October 6, CMS posted a special MLN Matters article directing providers to available resources...
-
Medicare Insider, Issue 41, October 12, 2010
First, CMS published a new document this week called the “Medicare Quarterly Provider...
-
Medicare Insider, Issue 40, October 5, 2010
Transmittals and MLN Matters articles: CMS MLN Matters articles on ICR programs, CPT code 80101...
-
Medicare Insider, Issue 40, October 5, 2010
Other Issuances: OIG releases 2011 Work Plan, CMS announces SHIP funding awards, NCD lab manual...
-
Medicare Insider, Issue 40, October 5, 2010
The next Hospital & Hospital Quality Open Door Forum conference call will be held 2 - 3 pm...
-
Medicare Insider, Issue 39, September 28, 2010
How do you handle a Medicare swing bed patient that requires heart cath at another facility?
-
Medicare Insider, Issue 39, September 28, 2010
On September 17, CMS issued its quarterly OPPS update instructions, which includes additional...
-
Medicare Insider, Issue 38, September 21, 2010
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 37, September 14, 2010
On September 3, CMS posted a transmittal to implement the quarterly update to the integrated...
-
Medicare Insider, Issue 37, September 14, 2010
On September 9, CMS posted a message to its acute care hospital listserv to clarify and announce...
-
Medicare Insider, Issue 37, September 14, 2010
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...
-
Medicare Insider, Issue 36, September 7, 2010
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 35, August 31, 2010
On August 20, CMS issued a transmittal instructing contractors to provide local guidance on the...
-
Medicare Insider, Issue 35, August 31, 2010
CMS recently released the ESRD PPS final rule, which will become effective for services provided on...
-
Medicare Insider, Issue 34, August 24, 2010
The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, August 26...
-
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...
-
Medicare Insider, Issue 33, August 17, 2010
On August 10, CMS issued a special edition MLN Matters article on medical record retention and...
-
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...
-
Medicare Insider, Issue 33, August 17, 2010
There are no public events this week.
-
Medicare Insider, Issue 32, August 10, 2010
On August 4, CMS issued a transmittal to replace its previous instruction regarding implementation...
-
Medicare Insider, Issue 32, August 10, 2010
At one time Dental services were not covered by Medicare in an hospital. We billed...
-
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...
-
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...
-
Medicare Insider, Issue 31, August 3, 2010
I would like to know how other hospitals are addressing self administered drugs (SAD) in...
-
Medicare Insider, Issue 31, August 3, 2010
There are no public events this week.
-
Medicare Insider, Issue 31, August 3, 2010
CMS has posted several tip sheets aimed at explaining the EHR incentive program to hospitals.
-
Medicare Insider, Issue 31, August 3, 2010
On July 30, CMS issued a transmittal to make changes to the common working file (CWF) regarding...
-
Medicare Insider, Issue 31, August 3, 2010
On July 28, CMS published in the Federal Register a final rule to define “meaningful...
-
Medicare Insider, Issue 30, July 27, 2010
MedicareFind subscribers now have access to the written transcript and audio recording of the...
-
Medicare Insider, Issue 30, July 27, 2010
On July 16, CMS issued a transmittal to revise the State Operations Manual, making changes that...
-
Medicare Insider, Issue 30, July 27, 2010
On July 22, CMS published in the Federal Register a notice to update the inpatient rehabilitation...
-
Medicare Insider, Issue 30, July 27, 2010
Last week, we talked about the changes that CMS announced under the Patient Protection and...
-
Medicare Insider, Issue 29, July 20, 2010
On July 16, CMS issued a display copy of a notice to update the inpatient rehabilitation facility...
-
Medicare Insider, Issue 29, July 20, 2010
On July 14, the OIG issued an analysis of errors identified in the fiscal year 2009 comprehensive...
-
Medicare Insider, Issue 28, July 13, 2010
On June 29, the OIG issued a review of inpatient rehabilitation facilities’ (IRF) compliance...
-
Medicare Insider, Issue 28, July 13, 2010
On July 9, CMS issued transmittals to the National Coverage Determinations Manual and the Claims...
-
Medicare Insider, Issue 25, June 22, 2010
On June 18, HHS released a display copy of the final rule establishing a temporary certification...
-
Medicare Insider, Issue 24, June 15, 2010
MedicareFind subscribers now have access to the written transcript and audio recording of the...
-
Medicare Insider, Issue 24, June 15, 2010
MedicareFind users can now access appeals decisions made by the Provider Reimbursement Review...
-
Medicare Insider, Issue 24, June 15, 2010
Last week we discussed CMS’ clarifications regarding supervision requirements for hospital...
-
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...
-
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...
-
Medicare Insider, Issue 23, June 8, 2010
MedicareFind subscribers can now access the written transcripts of the nationwide RAC 101 call...
-
Medicare Insider, Issue 21, May 25, 2010
The three-day payment window, sometimes known incorrectly as the “72-hour rule,” has...
-
Medicare Insider, Issue 21, May 25, 2010
The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, May 27, 2010...
-
Medicare Insider, Issue 21, May 25, 2010
The recently enacted Patient Protection and Affordable Care Act (and companion Health Care and...
-
Medicare Insider, Issue 21, May 25, 2010
On May 21, CMS issued display copies of two Federal Register entries that would make changes to...
-
Medicare Insider, Issue 20, May 18, 2010
CMS has issued revised Addendum A and Addendum B data files to reflect changes under the Patient...
-
Medicare Insider, Issue 20, May 18, 2010
CMS released several MLN Matters articles related to transmittals previously outlined in Medicare...
-
Medicare Insider, Issue 20, May 18, 2010
In transmittal R696OTN published earlier this month, Medicare reminded hospitals of the...
-
Medicare Insider, Issue 19, May 11, 2010
On May 7, CMS issued transmittals to the Claims Processing Manual and Benefit Policy Manual to...
-
Medicare Insider, Issue 19, May 11, 2010
On May 5, CMS published in the Federal Register an interim final rule to implement various...
-
Medicare Insider, Issue 18, May 4, 2010
This week CMS issued clarification on a couple of drug billing related issues. In Claims...
-
Medicare Insider, Issue 18, May 4, 2010
On May 3, the Office for Civil Rights (OCR) published in the Federal Register a request for...
-
Medicare Insider, Issue 18, May 4, 2010
On April 30, CMS issued a transmittal to clarify what “administered” means in the...
-
Medicare Insider, Issue 17, April 27, 2010
CMS has posted a display copy of proposed rulemaking under the IPPS for FY 2011.
-
Medicare Insider, Issue 17, April 27, 2010
The FY 2011 IPPS proposed rule contains a reduction in the standardized amount reflecting an...
-
Medicare Insider, Issue 16, April 20, 2010
Transmittals and MLN Matters articles: CMS revises several previous transmittals and issues MLN...
-
Medicare Insider, Issue 15, April 13, 2010
CMS released a display copy of rulemaking containing the capitation rates for Medicare Advantage...
-
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...
-
Medicare Insider, Issue 15, April 13, 2010
Health Data Insights, the Region D RAC, has updated its description of an existing audit issue.
-
Medicare Insider, Issue 15, April 13, 2010
The next Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for...
-
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...
-
Medicare Insider, Issue 13, March 30, 2010
The Medicare Appeals Council has issued a decision on one of the many outstanding appeals from the...
-
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...
-
Medicare Insider, Issue 12, March 23, 2010
On March 19, CMS issued a transmittal to communicate new edit spreadsheets to contractors able to...
-
Medicare Insider, Issue 12, March 23, 2010
The MedicareFind Forum is a free resource where you can ask and answer Medicare-related questions...
-
Medicare Insider, Issue 12, March 23, 2010
In the current regulatory environment there are many contractors that are charged with reviewing...
-
Medicare Insider, Issue 12, March 23, 2010
Join us Tuesday, April 6, to learn more about how MedicareFind™ can help you find the...
-
Medicare Insider, Issue 11, March 16, 2010
On March 5, CMS issued a transmittal to implement processing of more ICD-9 codes (diagnosis and...
-
Medicare Insider, Issue 11, March 16, 2010
A transcript and audio recording of the March 4 Hospital & Hospital Quality Open Door Forum are...
-
Medicare Insider, Issue 11, March 16, 2010
Last Tuesday, March 9, CMS hosted the Rural Health Open Door Forum for rural providers in which...
-
Medicare Insider, Issue 10, March 9, 2010
On February 26, CMS issued the April 2010 update to the OPPS. The update includes changes to...
-
Medicare Insider, Issue 10, March 9, 2010
CMS posted several new/updated frequently asked questions (FAQ).
-
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...
-
Medicare Insider, Issue 9, March 2, 2010
CGI Federal and Connolly Healthcare, the RACs for regions B and C, continue to update their lists...
-
Medicare Insider, Issue 9, March 2, 2010
CMS will host the next Hospital & Hospital Quality Open Door Forum at 2 pm (Eastern) Thursday...
-
Medicare Insider, Issue 9, March 2, 2010
This week several transmittals, including the April quarterly OPPS update, were listed on the...
-
Medicare Insider, Issue 8, February 23, 2010
During the last several months the OIG has been auditing hospital outpatient claims to Medicare for...
-
Medicare Insider, Issue 5, February 2, 2010
There are no events this week.
-
Medicare Insider, Issue 5, February 2, 2010
During the past several years, CMS has been revising and refining the “incident to&rdquo...
-
Medicare Insider, Issue 4, January 26, 2010
A transcript and audio recording of the January 14 Hospital & Hospital Quality Open Door Forum...
-
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...
-
Medicare Insider, Issue 3, January 19, 2010
On January 15, CMS released a one-time notification detailing various OIG reports that contain...
-
Medicare Insider, Issue 2, January 12, 2010
HealthDataInsights (HDI), the RAC for Region D, and DCS Healthcare, the RAC for Region A, have...
-
Medicare Insider, Issue 1, January 5, 2010
In the OPPS final rule, it was announced that there would be two new services covered under...
-
Medicare Insider, Issue 1, January 5, 2010
On December 31, CMS published in the Federal Register corrections to the previously issued OPPS...
-
Medicare Insider, Issue 1, January 5, 2010
CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare...
-
Medicare Insider, Issue 1, January 5, 2010
MedicareFind subscribers can now access a new Diagnostic Services Physician Supervision Addendum...
-
Medicare Insider, Issue 53, December 29, 2009
On December 21, CMS rescinded and replaced its previous OPPS update transmittal because of an error...
-
Medicare Insider, Issue 53, December 29, 2009
In the OPPS final rule, it was announced that there would be two new services covered under...
-
Medicare Insider, Issue 52, December 22, 2009
Judith previously discussed Transmittal R1840CP implementing a new modifier and instructions for...
-
Medicare Insider, Issue 52, December 22, 2009
On December 18, CMS issued a transmittal to make changes related to the timeframe for contractors...
-
Medicare Insider, Issue 52, December 22, 2009
On December 18, HealthDataInsights, the RAC for Region D, posted three new issues approved for...
-
Medicare Insider, Issue 51, December 15, 2009
On December 10, CMS published a correction in the Federal Register to the Medicare physician fee...
-
Medicare Insider, Issue 51, December 15, 2009
On Friday, CMS issued two transmittals containing manual provisions that incorporate key changes to...
-
Medicare Insider, Issue 51, December 15, 2009
On December 11, CMS issued two transmittals to incorporate OPPS updates into the Benefit Policy...
-
Medicare Insider, Issue 50, December 8, 2009
On December 4, CMS issued a transmittal to instruct contractors on the processing of claims that...
-
Medicare Insider, Issue 49, December 1, 2009
In a recent transmittal (R1840CP), CMS provides guidance on the voluntary use of ABNs. ABNs...
-
Medicare Insider, Issue 48, November 24, 2009
Providers should pay attention to two issues that were quietly discussed in the physician...
-
Medicare Insider, Issue 48, November 24, 2009
On November 20, CMS published in the Federal Register the 2010 OPPS final rule. CMS had previously...
-
Medicare Insider, Issue 47, November 17, 2009
On November 16, CMS issued a transmittal to update the claims processing system to apply the new...
-
Medicare Insider, Issue 47, November 17, 2009
The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday...
-
Medicare Insider, Issue 46, November 10, 2009
On November 6th, CMS published an update to the Provider Reimbursement Manual (PRM) with Medicare...
-
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...
-
Medicare Insider, Issue 45, November 3, 2009
On October 30, CMS released a display copy of the OPPS final rule for CY 2010.
-
Medicare Insider, Issue 45, November 3, 2009
CMS has released a display copy of the outpatient prospective payment system (OPPS) final rule for...
-
Medicare Insider, Issue 44, October 27, 2009
On October 22, CMS published in the Federal Register three notices to announce the inpatient...
-
Medicare Insider, Issue 44, October 27, 2009
On October 23, CMS issued a transmittal to update the reasonable charge for splints, casts...
-
Medicare Insider, Issue 41, October 6, 2009
The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Thursday, October...
-
Medicare Insider, Issue 41, October 6, 2009
On October 1, the OIG issued its Work Plan for FY 2010.
-
Medicare Insider, Issue 40, September 29, 2009
On September 25, CMS replaced its previous transmittal on LCD exceptions. It had previously sent...
-
Medicare Insider, Issue 39, September 22, 2009
On September 18, CMS rescinded and replaced two previous transmittals related to FDG PET coverage.
-
Medicare Insider, Issue 39, September 22, 2009
On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...
-
Medicare Insider, Issue 38, September 15, 2009
During the last few years, there has been considerable focus on certain events identified as...
-
Medicare Insider, Issue 37, September 8, 2009
CMS released several MLN Matters articles related to transmittals previously outlined in Medicare...
-
Medicare Insider, Issue 37, September 8, 2009
The transcript and audio of the August 26 Hospital Open Door Forum (ODF) conference call are now...
-
Medicare Insider, Issue 36, September 1, 2009
On August 28, CMS issued transmittal R549OTN, in which it provided instructions to the MACs for...
-
Medicare Insider, Issue 36, September 1, 2009
On Friday, CMS issued Medicare Claims Processing Manual (MCPM) transmittal 1803, which is the...
-
Medicare Insider, Issue 35, August 25, 2009
The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Wednesday, August...
-
Medicare Insider, Issue 34, August 18, 2009
Last week, I participated in an HCPro audioconference on HINNs. "HINN" stands for...
-
Medicare Insider, Issue 33, August 11, 2009
On August 7, CMS issued a transmittal (R105NCD) to implement its decision to maintain non-coverage...
-
Medicare Insider, Issue 33, August 11, 2009
On August 7, the inpatient rehabilitation facility prospective payment system (IRF PPS) final rule...
-
Medicare Insider, Issue 33, August 11, 2009
On August 7, CMS issued a transmittal to implement its decision to maintain noncoverage of computed...
-
Compliance Monitor, Issue 31, August 5, 2009
Continuing the trend of increased fraud enforcement, the Medicare Fraud Strike Force arrested 32...
-
Medicare Insider, Issue 32, August 4, 2009
On July 31, CMS issued a display copy of the 2010 IPPS final rule.
-
Medicare Insider, Issue 32, August 4, 2009
On July 31, 2009, CMS issued the IPPS final rule announcing the changes that will affect the...
-
Medicare Insider, Issue 31, July 28, 2009
CMS released two MLN Matters article related to transmittals previously outlined in Medicare Weekly...
-
Medicare Insider, Issue 31, July 28, 2009
On July 21, CMS posted an NCD for sleep testing for OSA.
-
Medicare Insider, Issue 31, July 28, 2009
CMS’ manual system is an important source of information and guidance — that’s...
-
Medicare Insider, Issue 30, July 21, 2009
In a May 12 post, clarification was given regarding a “non-patient” and reference...
-
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...
-
Medicare Insider, Issue 30, July 21, 2009
On July 21, CMS published the 2010 OPPS proposed rule in the Federal Register. The proposed rule...
-
Medicare Insider, Issue 29, July 14, 2009
We have received many questions on the articles we have published on the counting of hours of...
-
Medicare Insider, Issue 29, July 14, 2009
The next Hospital & Hospital Quality Open Door Forum (ODF) conference call is scheduled for...
-
Medicare Insider, Issue 29, July 14, 2009
On July 10, CMS issued a transmittal to update the interest rate for overpayments and underpayments...
-
Medicare Insider, Issue 28, July 7, 2009
On July 1, CMS issued a display copy of the OPPS proposed rule for CY 2010.
-
Medicare Insider, Issue 28, July 7, 2009
On July 2, CMS replaced its previous transmittals on the recently issued NCDs for wrong surgery...
-
Medicare Insider, Issue 28, July 7, 2009
On June 29, CMS posted on its Web site the three NCDs for surgical never events.
-
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...
-
Medicare Insider, Issue 27, June 30, 2009
Although there were several transmittals and other CMS issuances published during the past week...
-
Medicare Insider, Issue 27, June 30, 2009
On June 26, CMS instructed contractors to make system changes required for implementation of the...
-
Medicare Insider, Issue 27, June 30, 2009
CMS issued several new/updated frequently asked questions (FAQ).
-
Medicare Insider, Issue 25, June 16, 2009
In 2002, the National Quality Forum (NQF) published a list of 27 events identified as...
-
Medicare Insider, Issue 25, June 16, 2009
On June 12, CMS issued updates to the Claims Processing Manual and National Coverage Determinations...
-
Medicare Insider, Issue 24, June 10, 2009
This week, you’ll notice a difference in the Medicare Weekly Update. I’m pleased...
-
Medicare Insider, Issue 24, June 9, 2009
On June 5, CMS released a transmittal to implement the July 2009 update to HCPCS.
-
Medicare Insider, Issue 22, May 26, 2009
This week, CMS published the July Integrated Outpatient Code Editor (I/OCE). Although there...
-
Medicare Insider, Issue 21, May 19, 2009
On May 14, the OIG issued two reports on oxaliplatin billing. In both cases, the OIG determined...
-
Medicare Insider, Issue 20, May 12, 2009
CMS released Transmittal 1729 to the Claims Processing Manual this week, implementing provisions of...
-
Medicare Insider, Issue 19, May 5, 2009
On Friday May 1, CMS released the proposed inpatient prospective payment system (IPPS) rule for FY...
-
Medicare Insider, Issue 19, May 5, 2009
On May 1, CMS released a display copy of the IPPS proposed rule for fiscal year 2010.
-
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...
-
Compliance Monitor, Issue 17, April 29, 2009
Q: What is an invasive procedure?
-
Medicare Insider, Issue 16, April 21, 2009
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for April...
-
Medicare Insider, Issue 16, April 21, 2009
CMS has posted the April 2009 version of the NCD manual for clinical diagnostic laboratory services...
-
Medicare Insider, Issue 16, April 21, 2009
This was an especially light week for items from CMS for hospitals. This is, perhaps, because...
-
Medicare Insider, Issue 15, April 14, 2009
This week, let’s continue our focus on the so-called Condition Code 44 process. If followed...
-
Medicare Insider, Issue 15, April 14, 2009
On April 9, CMS lowered the interest rate for Medicare overpayments and underpayments from 11.375...
-
Medicare Insider, Issue 15, April 14, 2009
On April 9, the OIG released a review of high-dollar payments for Medicare outpatient claims...
-
Medicare Insider, Issue 14, April 7, 2009
This is the first of two additional Instructor’s Notes that will focus on Condition Code 44...
-
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...
-
Medicare Insider, Issue 13, March 31, 2009
Last week the American Health Lawyers Association held their annual Institute on Medicare and...
-
Medicare Insider, Issue 12, March 24, 2009
This week, CMS published an MLN Matters article related to the April update to the OPPS published...
-
Medicare Insider, Issue 12, March 24, 2009
On March 20, CMS issued a transmittal to change some portions of the State Operations Manual...
-
Compliance Monitor, Issue 11, March 18, 2009
The United States has reached a $2.3 million settlement with Victory Memorial, a not-for-profit...
-
Medicare Insider, Issue 11, March 17, 2009
Hospitals are ordinarily entitled to a full DRG payment when patients are discharged to their home...
-
Medicare Insider, Issue 11, March 17, 2009
On March 13, CMS issued its quarterly CCI edits update for April.
-
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...
-
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...
-
Medicare Insider, Issue 10, March 10, 2009
On March 3, CMS issued a final decision memo in which it establishes certain conditions of coverage...
-
Medicare Insider, Issue 9, March 3, 2009
Effective January 1, 2009, the CCI edits for evaluation and management (E&M), including...
-
Medicare Insider, Issue 9, March 3, 2009
On February 27, CMS released a transmittal announcing new waived tests approved by the FDA under...
-
Medicare Insider, Issue 9, March 3, 2009
On February 23, CMS posted an NCD for the Heartsbreath test for heart transplant rejection in which...
-
Medicare Insider, Issue 8, February 24, 2009
CMS issued Transmittal 1681 February 13, 2009, related to locality adjustment for payments made to...
-
Medicare Insider, Issue 8, February 24, 2009
CMS released several updated frequently asked questions (FAQ) last week, related to Medicare...
-
Medicare Insider, Issue 8, February 24, 2009
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
-
Compliance Monitor, Issue 7, February 18, 2009
Q: What is HETS? How do I connect to this system?
-
Medicare Insider, Issue 7, February 17, 2009
On February 13, CMS issued clarifying instructions on the calculation of payment amounts for...
-
Medicare Insider, Issue 7, February 17, 2009
On February 13, CMS issued a memo in which it clarifies its enforcement approach to certain changes...
-
Medicare Insider, Issue 5, February 3, 2009
On January 26, CMS issued an NCD for PTA in which, consistent with its previously issued decision...
-
Healthcare Auditing Weekly, Issue 4, January 27, 2009
CMS announced national coverage determinations (NCDs) for three preventable errors identified in...
-
Medicare Insider, Issue 4, January 27, 2009
Medicare has been going through a number of transitions recently. One of these transitions relates...
-
Medicare Insider, Issue 4, January 27, 2009
On January 26, CMS published in the Federal Register technical corrections to the 2009 OPPS final...
-
Medicare Insider, Issue 3, January 20, 2009
HHS sets ICD-10-CM/PCS adoption for 2013, CMS proposes changes to cytology proficiency testing (PT...
-
Medicare Insider, Issue 3, January 20, 2009
On January 15, CMS issued national coverage determinations (NCD) finalizing its proposals not to...
-
Medicare Insider, Issue 2, January 13, 2009
On January 8, CMS issued the first results of its Hospital Outpatient Quality Data Reporting...
-
Medicare Insider, Issue 53, December 30, 2008
This week, CMS published the laboratory Medicare National Coverage Determinations Coding Policy...
-
Medicare Insider, Issue 53, December 30, 2008
On December 24, CMS issued a transmittal maintaining its current NCD for PTA of the carotid artery...
-
Medicare Insider, Issue 53, December 30, 2008
CMS has released its January 2009 update to the NCD manual for clinical diagnostic laboratory...
-
Healthcare Auditing Weekly, Issue 48, December 23, 2008
CMS held a listening session December 18 regarding hospital-acquired conditions (HACs), never...
-
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...
-
Medicare Insider, Issue 52, December 23, 2008
On December 19, CMS issued its annual update to the furnishing fee for clotting factor.
-
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...
-
Compliance Monitor, Issue 90, December 17, 2008
Marie Weller King, registered nurse and owner of King and Associates, will serve 18 months in...
-
Medicare Insider, Issue 51, December 16, 2008
A colleague (another healthcare lawyer) contacted me last week to talk about CMS’s discussion...
-
Medicare Insider, Issue 51, December 16, 2008
On December 12, CMS updated its Program Integrity Manual to reflect recent changes to its...
-
Medicare Insider, Issue 51, December 16, 2008
On December 12, CMS issued 125 new/updated frequently asked questions related to Medicare...
-
Medicare Insider, Issue 50, December 9, 2008
On December 3, CMS published in the Federal Register revised final wage indices and hospital...
-
Medicare Insider, Issue 50, December 9, 2008
On December 3, the OIG issued its Semiannual Report to Congress for April 1–September 30 of...
-
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, Issue 12, December 1, 2008
Inside:
Examine short stays, avoid overpayment
Direct-to-consumer genetic testing is a state...
-
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...
-
Healthcare Auditing Weekly, Issue 42, November 11, 2008
In a review of Medicare capital disproportionate share hospital (DSH) payments, the OIG found that...
-
Medicare Insider, Issue 45, November 11, 2008
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 45, November 11, 2008
On November 7, CMS issued a transmittal implementing an update to HCPCS for 2009.
-
Medicare Insider, Issue 45, November 11, 2008
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
-
Compliance Monitor, Issue 84, November 5, 2008
CMS releases display copy of CY 2009 MPFS, seeks comments on Stark exception
-
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...
-
Medicare Insider, Issue 44, November 4, 2008
CMS has no public events scheduled for this week.
-
Medicare Insider, Issue 43, October 28, 2008
It was recently brought to my attention that some (perhaps many) hospitals may be using the...
-
Medicare Insider, Issue 43, October 28, 2008
CMS issued no significant regulations affecting hospital billing this week.
-
Medicare Insider, Issue 43, October 28, 2008
On October 24, CMS issued a transmittal recognizing four authoritative compendia for use in...
-
Medicare Insider, Issue 43, October 28, 2008
CMS has no public events scheduled for this week.
-
Medicare Insider, Issue 42, October 21, 2008
I taught a Medicare course in Chicago last week. One of the course participants from California...
-
Medicare Insider, Issue 42, October 21, 2008
On October 15, CMS issued a transmittal instructing Medicare contractors to implement an interest...
-
Medicare Insider, Issue 42, October 21, 2008
On October 16, the OIG issued a report on high-dollar payments for inpatient and outpatient claims...
-
Medicare Insider, Issue 42, October 21, 2008
CMS has no public events scheduled for this week.
-
Medicare Insider, Issue 41, October 14, 2008
CMS released two MLN Matters articles last week related to transmittals previously announced in...
-
Medicare Insider, Issue 41, October 14, 2008
CMS has no public events scheduled for this week.
-
Compliance Monitor, Issue 78, October 8, 2008
Tip: Guidelines for documenting screening treatment
-
Medicare Insider, Issue 40, October 7, 2008
There were a number of significant regulatory developments last week, including the release of the...
-
Medicare Insider, Issue 40, October 7, 2008
On October 3, CMS published in the Federal Register a notice providing the wage indices, hospital...
-
Medicare Insider, Issue 40, October 7, 2008
On October 3, CMS issued a transmittal implementing FY 2009 changes for IPPS hospitals. The...
-
Medicare Insider, Issue 40, October 7, 2008
On October 3, the OIG released a report on high-dollar payments that National Government Services...
-
Medicare Insider, Issue 40, October 7, 2008
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
-
Medicare Insider, Issue 39, September 30, 2008
CMS released two MLN Matters articles last week related to transmittals previously announced in...
-
Medicare Insider, Issue 39, September 30, 2008
On September 26, CMS issued two revised NCDs, one for heart transplants and one for artificial...
-
Medicare Insider, Issue 39, September 30, 2008
CMS has no public events scheduled for this week.
-
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.
-
Medicare Insider, Issue 38, September 23, 2008
On September 19, CMS released the fourth quarter update to the NCCI edits.
-
Medicare Insider, Issue 38, September 23, 2008
On September 15, the OIG issued a report on high-dollar payments for inpatient services processed...
-
Medicare Insider, Issue 38, September 23, 2008
CMS has no public events scheduled for this week.
-
Medicare Insider, Issue 37, September 16, 2008
On September 12, CMS published in the Federal Register a correction to the IRF PPS. The correction...
-
Medicare Insider, Issue 37, September 16, 2008
On September 12, CMS rescinded its May 20, 2008, transmittal (Change Request 6012) regarding the...
-
Medicare Insider, Issue 37, September 16, 2008
CMS has no public events scheduled for this week.
-
Medicare Insider, Issue 36, September 9, 2008
On September 5, CMS released revised manual instructions on limitation on liability, including use...
-
Medicare Insider, Issue 36, September 9, 2008
CMS has no public events scheduled for this week.
-
Medicare Insider, Issue 35, September 3, 2008
As reported below, CMS issued a transmittal last week (Change Request 6100) updating Section 80.6.1...
-
Medicare Insider, Issue 35, September 3, 2008
On August 29, CMS issued two transmittals implementing its May 1 NCD that established coverage for...
-
Medicare Insider, Issue 35, September 3, 2008
CMS has no public events scheduled for this week.
