Corporate Compliance Articles by Topic: Medicare Coverage and Reimbursement
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Medicare Weekly Update, Issue 47, November 17, 2009
On November 16, CMS issued a transmittal to update the claims processing system to apply the new...
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Medicare Weekly Update, Issue 47, November 17, 2009
The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday...
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Medicare Weekly Update, Issue 46, November 10, 2009
On November 6th, CMS published an update to the Provider Reimbursement Manual (PRM) with Medicare...
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Medicare Weekly Update, Issue 46, November 10, 2009
On November 4, CMS published a notice in the Federal Register to extend the comment period on its...
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Medicare Weekly Update, Issue 45, November 3, 2009
On October 30, CMS released a display copy of the OPPS final rule for CY 2010.
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Medicare Weekly Update, Issue 45, November 3, 2009
CMS has released a display copy of the outpatient prospective payment system (OPPS) final rule for...
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Medicare Weekly Update, Issue 44, October 27, 2009
On October 22, CMS published in the Federal Register three notices to announce the inpatient...
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Medicare Weekly Update, Issue 44, October 27, 2009
On October 23, CMS issued a transmittal to update the reasonable charge for splints, casts...
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Medicare Weekly Update, Issue 41, October 6, 2009
The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Thursday, October...
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Medicare Weekly Update, Issue 41, October 6, 2009
On October 1, the OIG issued its Work Plan for FY 2010.
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Medicare Weekly Update, Issue 40, September 29, 2009
On September 25, CMS replaced its previous transmittal on LCD exceptions. It had previously sent...
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Medicare Weekly Update, Issue 39, September 22, 2009
On September 18, CMS rescinded and replaced two previous transmittals related to FDG PET coverage.
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Medicare Weekly Update, Issue 39, September 22, 2009
On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...
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Medicare Weekly Update, Issue 38, September 15, 2009
During the last few years, there has been considerable focus on certain events identified as...
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Medicare Weekly Update, Issue 37, September 8, 2009
CMS released several MLN Matters articles related to transmittals previously outlined in Medicare...
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Medicare Weekly Update, Issue 37, September 8, 2009
The transcript and audio of the August 26 Hospital Open Door Forum (ODF) conference call are now...
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Medicare Weekly Update, Issue 36, September 1, 2009
On August 28, CMS issued transmittal R549OTN, in which it provided instructions to the MACs for...
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Medicare Weekly Update, Issue 36, September 1, 2009
On Friday, CMS issued Medicare Claims Processing Manual (MCPM) transmittal 1803, which is the...
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Medicare Weekly Update, Issue 35, August 25, 2009
The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Wednesday, August...
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Medicare Weekly Update, Issue 34, August 18, 2009
Last week, I participated in an HCPro audioconference on HINNs. "HINN" stands for...
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Medicare Weekly Update, Issue 33, August 11, 2009
On August 7, CMS issued a transmittal (R105NCD) to implement its decision to maintain non-coverage...
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Medicare Weekly Update, Issue 33, August 11, 2009
On August 7, the inpatient rehabilitation facility prospective payment system (IRF PPS) final rule...
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Medicare Weekly Update, Issue 33, August 11, 2009
On August 7, CMS issued a transmittal to implement its decision to maintain noncoverage of computed...
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Compliance Monitor, Issue 31, August 5, 2009
Continuing the trend of increased fraud enforcement, the Medicare Fraud Strike Force arrested 32...
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Medicare Weekly Update, Issue 32, August 4, 2009
On July 31, CMS issued a display copy of the 2010 IPPS final rule.
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Medicare Weekly Update, Issue 32, August 4, 2009
On July 31, 2009, CMS issued the IPPS final rule announcing the changes that will affect the...
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Medicare Weekly Update, Issue 31, July 28, 2009
CMS released two MLN Matters article related to transmittals previously outlined in Medicare Weekly...
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Medicare Weekly Update, Issue 31, July 28, 2009
On July 21, CMS posted an NCD for sleep testing for OSA.
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Medicare Weekly Update, Issue 31, July 28, 2009
CMS’ manual system is an important source of information and guidance — that’s...
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Medicare Weekly Update, Issue 30, July 21, 2009
In a May 12 post, clarification was given regarding a “non-patient” and reference...
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Medicare Weekly Update, Issue 30, July 21, 2009
On July 17, CMS issued two transmittals to implement its recent NCD for FDG PET for solid tumors...
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Medicare Weekly Update, Issue 30, July 21, 2009
On July 21, CMS published the 2010 OPPS proposed rule in the Federal Register. The proposed rule...
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Medicare Weekly Update, Issue 29, July 14, 2009
We have received many questions on the articles we have published on the counting of hours of...
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Medicare Weekly Update, Issue 29, July 14, 2009
The next Hospital & Hospital Quality Open Door Forum (ODF) conference call is scheduled for...
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Medicare Weekly Update, Issue 29, July 14, 2009
On July 10, CMS issued a transmittal to update the interest rate for overpayments and underpayments...
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Medicare Weekly Update, Issue 28, July 7, 2009
On July 1, CMS issued a display copy of the OPPS proposed rule for CY 2010.
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Medicare Weekly Update, Issue 28, July 7, 2009
On July 2, CMS replaced its previous transmittals on the recently issued NCDs for wrong surgery...
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Medicare Weekly Update, Issue 28, July 7, 2009
On June 29, CMS posted on its Web site the three NCDs for surgical never events.
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Medicare Weekly Update, Issue 28, July 7, 2009
This was a busy week, but the biggest news was the somewhat early release of the OPPS proposed rule...
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Medicare Weekly Update, Issue 27, June 30, 2009
Although there were several transmittals and other CMS issuances published during the past week...
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Medicare Weekly Update, Issue 27, June 30, 2009
On June 26, CMS instructed contractors to make system changes required for implementation of the...
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Medicare Weekly Update, Issue 27, June 30, 2009
CMS issued several new/updated frequently asked questions (FAQ).
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Medicare Weekly Update, Issue 25, June 16, 2009
In 2002, the National Quality Forum (NQF) published a list of 27 events identified as...
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Medicare Weekly Update, Issue 25, June 16, 2009
On June 12, CMS issued updates to the Claims Processing Manual and National Coverage Determinations...
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Medicare Weekly Update, Issue 24, June 10, 2009
This week, you’ll notice a difference in the Medicare Weekly Update. I’m pleased...
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Medicare Weekly Update, Issue 24, June 9, 2009
On June 5, CMS released a transmittal to implement the July 2009 update to HCPCS.
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Medicare Weekly Update, Issue 22, May 26, 2009
This week, CMS published the July Integrated Outpatient Code Editor (I/OCE). Although there...
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Medicare Weekly Update, Issue 21, May 19, 2009
On May 14, the OIG issued two reports on oxaliplatin billing. In both cases, the OIG determined...
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Medicare Weekly Update, Issue 20, May 12, 2009
CMS released Transmittal 1729 to the Claims Processing Manual this week, implementing provisions of...
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Medicare Weekly Update, Issue 19, May 5, 2009
On Friday May 1, CMS released the proposed inpatient prospective payment system (IPPS) rule for FY...
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Medicare Weekly Update, Issue 19, May 5, 2009
On May 1, CMS released a display copy of the IPPS proposed rule for fiscal year 2010.
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Medicare Weekly Update, Issue 19, May 5, 2009
On April 23, the OIG released a report on outpatient payments for oxaliplatin made in 2004 and 2005...
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Compliance Monitor, Issue 17, April 29, 2009
Q: What is an invasive procedure?
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Medicare Weekly Update, Issue 16, April 21, 2009
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for April...
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Medicare Weekly Update, Issue 16, April 21, 2009
CMS has posted the April 2009 version of the NCD manual for clinical diagnostic laboratory services...
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Medicare Weekly Update, Issue 16, April 21, 2009
This was an especially light week for items from CMS for hospitals. This is, perhaps, because...
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Medicare Weekly Update, Issue 15, April 14, 2009
This week, let’s continue our focus on the so-called Condition Code 44 process. If followed...
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Medicare Weekly Update, Issue 15, April 14, 2009
On April 9, CMS lowered the interest rate for Medicare overpayments and underpayments from 11.375...
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Medicare Weekly Update, Issue 15, April 14, 2009
On April 9, the OIG released a review of high-dollar payments for Medicare outpatient claims...
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Medicare Weekly Update, Issue 14, April 7, 2009
This is the first of two additional Instructor’s Notes that will focus on Condition Code 44...
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Medicare Weekly Update, Issue 14, April 7, 2009
On April 3, CMS posted a final decision memo in which it announced revisions to Section 220.6 of...
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Medicare Weekly Update, Issue 13, March 31, 2009
Last week the American Health Lawyers Association held their annual Institute on Medicare and...
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Medicare Weekly Update, Issue 12, March 24, 2009
This week, CMS published an MLN Matters article related to the April update to the OPPS published...
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Medicare Weekly Update, Issue 12, March 24, 2009
On March 20, CMS issued a transmittal to change some portions of the State Operations Manual...
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Compliance Monitor, Issue 11, March 18, 2009
The United States has reached a $2.3 million settlement with Victory Memorial, a not-for-profit...
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Medicare Weekly Update, Issue 11, March 17, 2009
Hospitals are ordinarily entitled to a full DRG payment when patients are discharged to their home...
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Medicare Weekly Update, Issue 11, March 17, 2009
On March 13, CMS issued its quarterly CCI edits update for April.
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Medicare Weekly Update, Issue 11, March 17, 2009
On March 11, the OIG issued a report in which it determined that hospitals improperly coded 15,051...
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Medicare Weekly Update, Issue 10, March 10, 2009
On March 6, CMS issued a transmittal in which it instructed hospitals submit data on their FY 2006...
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Medicare Weekly Update, Issue 10, March 10, 2009
On March 3, CMS issued a final decision memo in which it establishes certain conditions of coverage...
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Medicare Weekly Update, Issue 9, March 3, 2009
Effective January 1, 2009, the CCI edits for evaluation and management (E&M), including...
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Medicare Weekly Update, Issue 9, March 3, 2009
On February 27, CMS released a transmittal announcing new waived tests approved by the FDA under...
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Medicare Weekly Update, Issue 9, March 3, 2009
On February 23, CMS posted an NCD for the Heartsbreath test for heart transplant rejection in which...
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Medicare Weekly Update, Issue 8, February 24, 2009
CMS issued Transmittal 1681 February 13, 2009, related to locality adjustment for payments made to...
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Medicare Weekly Update, Issue 8, February 24, 2009
CMS released several updated frequently asked questions (FAQ) last week, related to Medicare...
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Medicare Weekly Update, Issue 8, February 24, 2009
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
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Compliance Monitor, Issue 7, February 18, 2009
Q: What is HETS? How do I connect to this system?
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Medicare Weekly Update, Issue 7, February 17, 2009
On February 13, CMS issued clarifying instructions on the calculation of payment amounts for...
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Medicare Weekly Update, Issue 7, February 17, 2009
On February 13, CMS issued a memo in which it clarifies its enforcement approach to certain changes...
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Medicare Weekly Update, Issue 5, February 3, 2009
On January 26, CMS issued an NCD for PTA in which, consistent with its previously issued decision...
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Healthcare Auditing Weekly, Issue 4, January 27, 2009
CMS announced national coverage determinations (NCDs) for three preventable errors identified in...
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Medicare Weekly Update, Issue 4, January 27, 2009
Medicare has been going through a number of transitions recently. One of these transitions relates...
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Medicare Weekly Update, Issue 4, January 27, 2009
On January 26, CMS published in the Federal Register technical corrections to the 2009 OPPS final...
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Medicare Weekly Update, Issue 3, January 20, 2009
HHS sets ICD-10-CM/PCS adoption for 2013, CMS proposes changes to cytology proficiency testing (PT...
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Medicare Weekly Update, Issue 3, January 20, 2009
On January 15, CMS issued national coverage determinations (NCD) finalizing its proposals not to...
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Medicare Weekly Update, Issue 2, January 13, 2009
On January 8, CMS issued the first results of its Hospital Outpatient Quality Data Reporting...
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Medicare Weekly Update, Issue 53, December 30, 2008
This week, CMS published the laboratory Medicare National Coverage Determinations Coding Policy...
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Medicare Weekly Update, Issue 53, December 30, 2008
On December 24, CMS issued a transmittal maintaining its current NCD for PTA of the carotid artery...
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Medicare Weekly Update, Issue 53, December 30, 2008
CMS has released its January 2009 update to the NCD manual for clinical diagnostic laboratory...
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Healthcare Auditing Weekly, Issue 48, December 23, 2008
CMS held a listening session December 18 regarding hospital-acquired conditions (HACs), never...
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Medicare Weekly Update, Issue 52, December 23, 2008
I thought I would do a follow-up to Hugh’s note last week about physician supervision. One of...
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Medicare Weekly Update, Issue 52, December 23, 2008
On December 19, CMS issued its annual update to the furnishing fee for clotting factor.
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Medicare Weekly Update, 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...
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Compliance Monitor, Issue 90, December 17, 2008
Marie Weller King, registered nurse and owner of King and Associates, will serve 18 months in...
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Medicare Weekly Update, Issue 51, December 16, 2008
A colleague (another healthcare lawyer) contacted me last week to talk about CMS’s discussion...
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Medicare Weekly Update, Issue 51, December 16, 2008
On December 12, CMS updated its Program Integrity Manual to reflect recent changes to its...
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Medicare Weekly Update, Issue 51, December 16, 2008
On December 12, CMS issued 125 new/updated frequently asked questions related to Medicare...
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Medicare Weekly Update, Issue 50, December 9, 2008
On December 3, CMS published in the Federal Register revised final wage indices and hospital...
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Medicare Weekly Update, Issue 50, December 9, 2008
On December 3, the OIG issued its Semiannual Report to Congress for April 1–September 30 of...
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Medicare Weekly Update, Issue 50, December 9, 2008
CMS has scheduled a listening session on hospital-acquired conditions (HAC) in inpatient and...
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Strategies for Health Care Compliance, Issue 12, December 1, 2008
Inside:
Examine short stays, avoid overpayment
Direct-to-consumer genetic testing is a state...
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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...
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Healthcare Auditing Weekly, Issue 42, November 11, 2008
In a review of Medicare capital disproportionate share hospital (DSH) payments, the OIG found that...
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Medicare Weekly Update, Issue 45, November 11, 2008
CMS issued no significant regulations affecting hospital billing this week.
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Medicare Weekly Update, Issue 45, November 11, 2008
On November 7, CMS issued a transmittal implementing an update to HCPCS for 2009.
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Medicare Weekly Update, Issue 45, November 11, 2008
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
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Compliance Monitor, Issue 84, November 5, 2008
CMS releases display copy of CY 2009 MPFS, seeks comments on Stark exception
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Medicare Weekly Update, Issue 44, November 4, 2008
On October 30, the OIG issued a review of CMS’ oversight of the HIPAA security rule. The OIG...
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Medicare Weekly Update, Issue 44, November 4, 2008
CMS has no public events scheduled for this week.
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Medicare Weekly Update, Issue 43, October 28, 2008
It was recently brought to my attention that some (perhaps many) hospitals may be using the...
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Medicare Weekly Update, Issue 43, October 28, 2008
CMS issued no significant regulations affecting hospital billing this week.
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Medicare Weekly Update, Issue 43, October 28, 2008
On October 24, CMS issued a transmittal recognizing four authoritative compendia for use in...
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Medicare Weekly Update, Issue 43, October 28, 2008
CMS has no public events scheduled for this week.
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Medicare Weekly Update, Issue 42, October 21, 2008
CMS has no public events scheduled for this week.
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Medicare Weekly Update, Issue 42, October 21, 2008
I taught a Medicare course in Chicago last week. One of the course participants from California...
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Medicare Weekly Update, Issue 42, October 21, 2008
On October 15, CMS issued a transmittal instructing Medicare contractors to implement an interest...
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Medicare Weekly Update, Issue 42, October 21, 2008
On October 16, the OIG issued a report on high-dollar payments for inpatient and outpatient claims...
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Medicare Weekly Update, Issue 41, October 14, 2008
CMS released two MLN Matters articles last week related to transmittals previously announced in...
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Medicare Weekly Update, Issue 41, October 14, 2008
CMS has no public events scheduled for this week.
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Compliance Monitor, Issue 78, October 8, 2008
Tip: Guidelines for documenting screening treatment
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Medicare Weekly Update, Issue 40, October 7, 2008
There were a number of significant regulatory developments last week, including the release of the...
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Medicare Weekly Update, Issue 40, October 7, 2008
On October 3, CMS published in the Federal Register a notice providing the wage indices, hospital...
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Medicare Weekly Update, Issue 40, October 7, 2008
On October 3, CMS issued a transmittal implementing FY 2009 changes for IPPS hospitals. The...
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Medicare Weekly Update, Issue 40, October 7, 2008
On October 3, the OIG released a report on high-dollar payments that National Government Services...
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Medicare Weekly Update, Issue 40, October 7, 2008
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
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Medicare Weekly Update, Issue 39, September 30, 2008
CMS released two MLN Matters articles last week related to transmittals previously announced in...
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Medicare Weekly Update, Issue 39, September 30, 2008
On September 26, CMS issued two revised NCDs, one for heart transplants and one for artificial...
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Medicare Weekly Update, Issue 39, September 30, 2008
CMS has no public events scheduled for this week.
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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.
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Medicare Weekly Update, Issue 38, September 23, 2008
On September 19, CMS released the fourth quarter update to the NCCI edits.
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Medicare Weekly Update, Issue 38, September 23, 2008
On September 15, the OIG issued a report on high-dollar payments for inpatient services processed...
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Medicare Weekly Update, Issue 38, September 23, 2008
CMS has no public events scheduled for this week.
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Medicare Weekly Update, Issue 37, September 16, 2008
On September 12, CMS published in the Federal Register a correction to the IRF PPS. The correction...
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Medicare Weekly Update, Issue 37, September 16, 2008
On September 12, CMS rescinded its May 20, 2008, transmittal (Change Request 6012) regarding the...
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Medicare Weekly Update, Issue 37, September 16, 2008
CMS has no public events scheduled for this week.
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Medicare Weekly Update, Issue 36, September 9, 2008
On September 5, CMS released revised manual instructions on limitation on liability, including use...
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Medicare Weekly Update, Issue 36, September 9, 2008
CMS has no public events scheduled for this week.
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Medicare Weekly Update, Issue 35, September 3, 2008
As reported below, CMS issued a transmittal last week (Change Request 6100) updating Section 80.6.1...
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Medicare Weekly Update, Issue 35, September 3, 2008
On August 29, CMS issued two transmittals implementing its May 1 NCD that established coverage for...
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Medicare Weekly Update, Issue 35, September 3, 2008
CMS has no public events scheduled for this week.