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  • Two-Midnight Rule: Initial Reviews to Resume

    Having taken time out for retraining and internal audits, contractors may resume initial-phase reviews of Medicare reimbursement claims for short-stay inpatient hospital care, CMS says.

  • Q&A: Submitting claims for observation services

    Q: Did something change with the observation services Composite APC in 2016? The director of patient financial services says we no longer receive payment for it.

  • Don't underestimate the importance of good documentation

    It’s an unfortunate part of healthcare today—the lawsuit. Are you ready if one is filed against your organization?

  • Q&A: Should we hardcode modifier -CT?

    Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed?

  • Bridge the communication gap with physicians with these tips

    Do you sometimes feel like you and the physicians at your hospital aren’t communicating as well as you could be? 


  • Q&A: Setting a price for corneal tissue

    Q: I have a follow-up question to an answer you gave early last year. The question was about reimbursement for the cost of corneal tissue. You stated “This line item should reflect the costs associated with the corneal tissue.” We have just started providing this service and are having a debate on what this statement means. I think we can apply our usual markup, but our cost accounting person thinks this means we can only pass along our invoice cost. What does it mean in regard to setting our price?

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Medicare Compliance Essentials Training Compendium


    Ensure compliance across your organization at an affordable price.

    HCPro has brought together seven of its most popular Medicare compliance training handbooks into a single collection, offering Medicare professionals a one-stop resource for regulatory and practical guidance. The Medicare Compliance Essentials Training Compendium is a full-size book featuring a brand-new introduction with guidelines on using the content and tools in each handbook for training purposes. The individual handbooks can also be downloaded and printed for training unlimited numbers of staff.

    Developed by industry-leading experts, this compendium simplifies Medicare compliance by providing a go-to source for training on critical billing and reimbursement issues, helping to ensure the delivery of a unified message throughout the organization. The book and downloadable handbooks cover topics such as:

    • Billing for ancillary bedside procedures
    • Patient status training for utilization review
    • Observation services
    • Condition codes 44 and W2
    • Inpatient-only procedures
    • Denials management
    • Revenue integrity

    Learn more