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Medicare Weekly Update
Each issue of Medicare Weekly Update includes the latest CMS proposed and final rules, CMS manual revisions, and transmittals. Readers also find OIG audit reports, advisory opinions, and more.
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Medicare Weekly Update
Issue 52, December 28, 2010
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Happy holidays from HCPro
On behalf of HCPro and those of us who work on Medicare Weekly Update and MedicareFind, I would... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Note: CMS implements durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program
In the past few years, DMEPOS services have been a primary focus by the Medicare enforcement... -
Transmittals and MLN Matters articles: CMS replaces transmittals, posts MLN Matters articles
CMS replaces transmittals, issues MLN Matters article -
Other Issuances: CMS issues OCE specifications, announces EHR registration date
CMS announced the availability of registration for the Medicare electronic health record (EHR... -
CMS Public Events: None this week
There are no public events this week.
Issue 51, December 21, 2010
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Note: PEPPERs are coming to CAHs
Last week, it was announced that critical access hospitals (CAHs) will be able to add a little... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS posts MLN Matters articles, replaces transmittals
On December 17, CMS issued a transmittal to incorporate a table of therapy CPT codes indicating... -
Other Issuances: CAHs to receive PEPPER data, OIG audits device replacement
TMF announced several updates to the Program for Evaluating Payment Patterns Electronic Report... -
CMS Public Events: None this week
There are no public events this week. -
MedicareFind Forum Spotlight: Inpatient-only procedures
If a Medicare OPPS claim has multiple procedures, let's say one with status indicator C and the...
Issue 50, December 14, 2010
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MedicareFind 2011 webcast calendar: Sign up for a free demonstration!
MedicareFind™ is changing the way your peers FIND the regulatory information they need to... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Note: Face validity assessment of ABNs required on all complex medical reviews
Last Friday, CMS issued transmittal R361PI requiring mandatory advanced beneficiary notices (ABNs... -
Transmittals and MLN Matters articles: CMS requires ABN assessment for complex medical review, clarifies "incident to" drug billing, and more
On December 10, CMS issued a transmittal to require that medical reviewers request all a mandatory... -
Other Issuances: No releases this week
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Public Events: None this week
There are no public events this week.
Issue 49, December 7, 2010
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Note: CMS issues implementing instructions for new annual wellness visit
This week CMS released 2 transmittals implementing the Annual Wellness Visit (AWV), including... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS posts special RAC article, implements annual wellness visit benefit, and more
On December 2, CMS issued the latest in a series of RAC program special MLN Matters articles. The... -
Other Issuances: CMS posts memo on IPPS changes
On November 26, CMS posted a memo covering changes in the recent 2011 IPPS final rule that affect... -
CMS Public Events: None this week
There are no public events this week.
Issue 48, November 30, 2010
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Note: Signature requirements for lab requisitions
Discussions regarding signature requirements for laboratory services have been going on for the... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS updates lab fee schedule, creates oil spill modifier/condition code, and more
On November 24, CMS issued a transmittal to provide instructions for the CY 2011 clinical... -
Other Issuances: OIG reviews devices and more
On November 19, the OIG issued a review of UMass Memorial Medical Center claims for outpatient... -
CMS Public Events: November 18 Hospital Open Door Forum transcript available
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...
Issue 47, November 23, 2010
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Note: CY2011 deductibles and coinsurance amounts, thoughts on physician supervision
This week, CMS published the transmittal with new manual sections implementing the new deductibles... -
Regulations: CMS issues final rule on visitation rights, requests ACO feedback, posts IRF PPS corrections
On November 19, CMS published in the Federal Register a rule to revise the Medicare Conditions of... -
Transmittals and MLN Matters articles: CMS posts new vaccine codes, implements CAH payments changes, and more
On November 19, CMS issued a transmittal to implement new HCPCS Q codes for 2010-2011 seasonal... -
Other Issuances: CMS posts new beneficiary forms, addresses improper payment trends, and more
CMS has posted new versions of the “Important Message from Medicare” and... -
CMS Public Events: No events this week
There are no public events this week.
Issue 46, November 16, 2010
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Note: CY 2011 OPPS final rule billing changes for 'included services' provided during critical care
As you are probably aware, CMS issued a display copy of the CY 2011 OPPS final rule on November... -
Regulations: CMS posts premiums, coinsurance rates for 2011
On November 9, CMS published three notices in the Federal Register to set various premium... -
Transmittals and MLN Matters articles: CMS expands IPPS transfer policy, issues article on ICD-10 implementation, implements edits, and more
On November 12, CMS issued a transmittal to expand the current IPPS transfer policy. Currently, a... -
Other Issuances: CMS issues new RAC information
CMS has issued new limits on additional documentation requests (ADR) under the RAC program. -
CMS Public Events: Hospital Open Door Forum November 18
The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, November 18... -
MedicareMentor Blog spotlight: Medicaid RACs
Join the discussion on the MedicareMentor Blog about CMS’ recent proposed rule regarding the...
Issue 45, November 9, 2010
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Note: OPPS final rule and physician supervision
It’s here! The OPPS final rule has been published in a display copy for your review as... -
Regulations: CMS issues Medicaid RAC proposals, posts OPPS final rule, and more
On November 5, CMS posted a proposed rule regarding the RAC expansion into Medicaid. The rule... -
Transmittals and MLN Matters articles: CMS issues MLN Matters articles, and more
On October 29, CMS issued a transmittal to instruct contractors that, for discharges on or after... -
Other Issuances: CMS posts RAC FAQ
Can a Recovery Audit Contractors (RAC) review a claim more than once? -
CMS Public Events: No events this week
There are no public events this week.
Issue 44, November 2, 2010
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Note: Special edition MLN Matters article on inpatient coding significantly revised
In late September, CMS published an MLN Matters article entitled "Recovery Audit Contractor... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS issues guidance on the three-day rule, revises documentation/coding guidance, implements point-of-origin updates, and more
On October 29, CMS issued a transmittal to provide guidance on the three-day payment window, as... -
Other Issuances: No releases this week
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Public Events: Medicaid integrity program call November 3
CMS is holding a special Open Door Forum 2 – 3 pm Wednesday, November 3, on the Medicaid... -
MedicareFind Forum Spotlight: EOMBs
Weigh in on a recent MedicareFind Forum question: Are paper EOMBs required under Medicare? Read...
Issue 43, October 26, 2010
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Note: Physician supervision and H.R. 6376
It was a relatively quite week again for CMS as we wait for the OPPS final rule to be announced... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS updates interest rate, posts MLN Matters articles, and more
On October 18, CMS issued a transmittal to instruct contractors to implement an interest rate of... -
Other Issuances: CMS posts RAC request limits for DME, OIG reviews high-dollar claims
On October 12, the OIG posted an audit of high-dollar payments for outpatient claims processed by... -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind Forum Spotlight: Pulmonary rehab
On a CMS transmittal it states that G0424 takes effective 1/1/10 for claims processed on or after... -
MedicareFind Spotlight: New survey and certification filter
MedicareFind users can take advantage of a new document type filter – Survey/Certification...
Issue 42, October 19, 2010
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Note: OIG reviews CMS’ use of error rate data
This week the OIG issued a report criticizing CMS’ use of the error rate data that they... -
Regulations: HHS revises EHR incentive program criteria
On October 13, HHS issued an interim final rule to revise the standards and certification criteria... -
Transmittals and MLN Matters articles: CMS implements revenue codes, issues EHR instructions, and more
On October 15, CMS issued a one-time notification to implement new revenue codes created by the... -
Other Issuances: OIG reviews CMS use of FFS error data
On October 7, the OIG issued a review of use of Medicare fee-for-service (FFS) error rate data to... -
CMS Public Events: October 7 Hospital Open Door Forum transcript available
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital... -
MedicareFind Spotlight: Three-day rule archive
Check out MedicareFind’s new three-day rule EasyFind page—an archive of various...
Issue 41, October 12, 2010
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Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Note: CMS publishes first quarterly compliance newsletter; update on three-day rule and physician offices
First, CMS published a new document this week called the “Medicare Quarterly Provider... -
Transmittals and MLN Matters articles: CMS updates OPPS hook and hold, reissues transmittals, and more
On October 6, CMS posted a special MLN Matters article directing providers to available resources... -
Other Issuances: CMS posts compliance newsletter
CMS has posted the first issue of a quarterly compliance newsletter aimed at providers. This... -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind spotlight: NCCI edits updated
Updated NCCI edits are now available on MedicareFind. The MedicareFind NCCI Edit Lookup Tool is...
Issue 40, October 5, 2010
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Note: CMS announces first two approved intensive cardiac rehab programs
Note: CMS announces first two approved intensive cardiac rehab programs -
Regulations: CMS posts IPPS corrections
Regulations: CMS posts IPPS corrections -
Transmittals and MLN Matters articles: CMS MLN Matters articles on ICR programs, CPT code 80101, and FDG PET for initial treatment strategy in tumors and myeloma
Transmittals and MLN Matters articles: CMS MLN Matters articles on ICR programs, CPT code 80101... -
Other Issuances: OIG releases 2011 Work Plan, CMS announces SHIP funding awards, NCD lab manual quarterly update, quarterly OPPS updates, quarterly MUE files, new FAQs, and more
Other Issuances: OIG releases 2011 Work Plan, CMS announces SHIP funding awards, NCD lab manual... -
CMS Public Events: Hospital Open Door Forum October 7
The next Hospital & Hospital Quality Open Door Forum conference call will be held 2 - 3 pm...
Issue 39, September 28, 2010
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Note: Relief from Modifier GA denials and new Condition Code 44 Billing Guidance
In a December 22, 2009, post, we discussed the significant problems CMS’ planned automatic... -
Regulations: CMS updates threshold amounts for ALJ, judicial review
On September 24, CMS published a notice in the Federal Register to update the... -
Transmittals and MLN Matters articles: CMS posts RAC articles, issues condition code 44 language, suspends automatic -GA denials, and more
On September 17, CMS issued its quarterly OPPS update instructions, which includes additional... -
Other Issuances: CMS posts EHR incentive FAQs
CMS has posted new FAQs on the Medicare and Medicaid EHR incentive programs. -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind Forum Spotlight: Swing bed scenario
How do you handle a Medicare swing bed patient that requires heart cath at another facility?
Issue 38, September 21, 2010
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Note: Critical access hospitals and the IPPS final rule
Last week was a fairly quiet week for CMS and no major regulation changes or announcements were... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS updates codes subject to SNF consolidated billing, expands CAH edits, and more
On September 10, CMS issued a transmittal to implement the annual HCPCS update under the skilled... -
Other Issuances: CMS posts draft documents for Medicaid RAC expansion
On September 10, CMS released a draft information collection form and supporting documents as its... -
CMS Public Events: No events this week
There are no public events this week.
Issue 37, September 14, 2010
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Note: CMS Changes Guidance on Date of Service Reporting for Three-Day Payment Window
CMS released through one of their provider listservs last week revised guidance on reporting the... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS updates I/OCE, reason codes, and more
On September 3, CMS posted a transmittal to implement the quarterly update to the integrated... -
Other Issuances: CMS updates three-day rule guidance, OIG audits bad debt
On September 9, CMS posted a message to its acute care hospital listserv to clarify and announce... -
CMS Public Events: August 26 Hospital Open Door Forum transcript available
MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...
Issue 36, September 7, 2010
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Note: New Billing Guidance for Procedures under the Three Day Rule
Note: New Billing Guidance for Procedures under the Three Day Rule -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS issues quarterly updates, reorganizes Program Integrity Manual, and more
Transmittals and MLN Matters articles: CMS issues quarterly updates, reorganizes Program Integrity... -
Other Issuances: CMS updates I/OCE, Connolly begins medical necessity audits, and more
Other Issuances: CMS updates I/OCE, Connolly begins medical necessity audits, and more -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind Forum Spotlight: Self-administered drugs
Join the MedicareFind Forum discussion of self-administered drugs. Register for free to contribute...
Issue 35, August 31, 2010
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Note: ESRD PPS final rule released effective for CY 2011
CMS recently released the ESRD PPS final rule, which will become effective for services provided on... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS instructs on discarded drugs/biologicals, implements ESRD PPS
On August 20, CMS issued a transmittal instructing contractors to provide local guidance on the... -
Other Issuances: CMS reminds industry of 5010 testing deadline
On August 24, CMS posted a release to healthcare providers, health plans, clearinghouses, and... -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind Forum Spotlight: Provider-based billing
In a provider based organization, how would we bill a situation when a patient has a E/M visit in... -
MedicareFind Spotlight: EHR incentive program archive
Check out the MedicareFind’s new EHR incentive program EasyFind page—an archive of...
Issue 34, August 24, 2010
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Note: Just one week left to submit comments on the 2011 OPPS proposed rule!
With just a week left to submit comments on the OPPS Proposed Rule for CY 2011, this seems a good... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS issues MLN Matters articles on IRFs, POA
CMS issued the following MLN Matters articles related to transmittals previously outlined in... -
Other Issuances: HDI begins medical necessity reviews, CMS posts EHR FAQs
HealthDataInsights (HDI), the RAC for Region D, has posted its first set of medical necessity... -
CMS Public Events: Hospital Open Door Forum August 26
The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, August 26... -
MedicareFind Forum: Post your question
Use the MedicareFind Forum to ask and answer Medicare-related questions. Register for free to post...
Issue 33, August 17, 2010
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Note: It’s here... Medical necessity RAC reviews
What would be more appropriate than rolling out medical necessity reviews on Friday the... -
Regulations: CMS publishes final rules for FY 2011 IPPS, ESRD PPS
On August 16, CMS published in the Federal Register a final rule making changes to the IPPS for... -
Transmittals and MLN Matters articles: CMS revises POA process, updates IRF PPS, issues special article on medical record retention, and more
On August 10, CMS issued a special edition MLN Matters article on medical record retention and... -
Other Issuances: RACs begin medical necessity reviews, OIG reviews separately billed outpatient infusion therapy services
On August 13, CGI Federal, the Region B RAC, posted the first issues for medical necessity review. -
CMS Public Events: No events this week
There are no public events this week. -
MedicareMentor Blog Spotlight: Carving out procedure time from observation hours
Participate in the discussion on the MedicareMentor Blog regarding how to carve out procedure time...
Issue 32, August 10, 2010
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Note: New Timely Filing Rules Significantly Shorten Time to File Medicare Claims
The Patient Protection and Affordable Care Act included a provision that limited timely filing of... -
Regulations: CMS publishes 2011 OPPS proposed rule
On August 3, CMS published in the Federal Register the 2011 OPPS proposed rule (CMS-1504-P). Among... -
Transmittals and MLN Matters articles: CMS replaces ICD-9-CM transmittal, modifies pricers, and more
On August 4, CMS issued a transmittal to replace its previous instruction regarding implementation... -
Other Issuances: No releases this week
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Public Events: CMS to hold EHR incentive program calls this week
CMS is holding three conference calls this week on the EHR incentive program. For registration and... -
MedicareFind Forum Spotlight: Dental Claims
At one time Dental services were not covered by Medicare in an hospital. We billed...
Issue 31, August 3, 2010
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Note: 2011 IPPS Final Rule includes Interim Final Rule on Three Day Window
Although I haven’t digested the 1,877 pages of the display copy of the 2011 IPPS Final Rule... -
Regulations: CMS releases 2011 IPPS rulemaking, publishes EHR rule, and more
On July 28, CMS published in the Federal Register a final rule to define “meaningful... -
Transmittals and MLN Matters articles: CMS instructs on timely filing, implements IPF interrupted stay policy, and more
On July 30, CMS issued a transmittal to make changes to the common working file (CWF) regarding... -
CMS releases tip sheets for EHR incentive program
CMS has posted several tip sheets aimed at explaining the EHR incentive program to hospitals. -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind Forum Spotlight: Self-administered drugs
I would like to know how other hospitals are addressing self administered drugs (SAD) in...
Issue 30, July 27, 2010
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Note: Latest CMS transmittal changes OPPS rates - again
Last week, we talked about the changes that CMS announced under the Patient Protection and... -
Regulations: CMS publishes IRF PPS update in Federal Register
On July 22, CMS published in the Federal Register a notice to update the inpatient rehabilitation... -
Transmittals and MLN Matters articles: CMS updates SOM, issues quarterly lab NCD and interest rate update, and more
On July 16, CMS issued a transmittal to revise the State Operations Manual, making changes that... -
Other Issuances: CMS posts new RAC questions and answers
What specific information does the provider community need to submit to when responding to a... -
CMS Public Events: Hospital Open Door Forum transcript available
MedicareFind subscribers now have access to the written transcript and audio recording of the... -
MedicareFind Forum: Respond to recent posts
Respond to recent posts
Issue 29, July 20, 2010
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Apply to be an HCPro Instructor/Regulatory Specialist
We are seeking part-time Instructors/Regulatory Specialists who will teach our Medicare Boot Camp... -
Note: Further clarification on important changes to inpatient and outpatient hospital reimbursement under PPACA
In a recent transmittal (R726OTN), CMS provided further clarification on changes to inpatient... -
Regulations: CMS, HHS post EHR incentive program final rules, CMS issues IRF PPS update, and more
On July 16, CMS issued a display copy of a notice to update the inpatient rehabilitation facility... -
Transmittals and MLN Matters articles: CMS issues special edition RAC article
On July 12, CMS issued the first in a series of articles to disseminate information on RAC... -
Other Issuances: OIG analyzes 2009 CERT errors
On July 14, the OIG issued an analysis of errors identified in the fiscal year 2009 comprehensive... -
CMS Public Events: EHR incentive program conference call July 22
CMS and The Office of the National Coordinator for Health Information Technology (ONC) will hold a...
Issue 28, July 13, 2010
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Volunteers needed!
HCPro is seeking volunteers to provide feedback for one of our online products. We are looking for... -
CMS Issues Proposals for new Physician Supervision requirements
On July 2, CMS published the OPPS Proposed Rule for 2011 ahead of anticipated... -
Regulations: CMS proposes OPPS changes, HHS issues HIPAA-HITECH regulations
On July 8, HHS posted a display copy of a proposed rule to modify HIPAA privacy, security, and... -
Transmittals and MLN Matters articles: CMS posts MRA coverage changes, implements PPACA changes, and more
On July 9, CMS issued transmittals to the National Coverage Determinations Manual and the Claims... -
Other Issuances: OIG posts audits of IRF transfers, oxaliplatin, and more
On June 29, the OIG issued a review of inpatient rehabilitation facilities’ (IRF) compliance... -
CMS Public Events: Hospital Open Door Forum July 15
CMS will hold the next Hospital & Hospital Quality Open Door Forum Thursday, July 15, from 2...
Issue 27, July 6, 2010
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Why is CMS expanding its code processing?
This week CMS published Frequently Asked Question #10060, regarding why institutional claims will... -
Regulations: CMS proposes revised hospital/CAH CoPs
On June 28, CMS published in the Federal Register proposed changes to the conditions of... -
Transmittals and MLN Matters articles: CMS implements MPFS updates, issues MLN Matters articles
On June 25, CMS issued a transmittal to amend the 2010 MPFS payment files. -
Other Issuances: CMS posts quarterly updates to data files, OIG audits neulasta, and more
CMS has posted a revised Addendum A and Addendum B under the OPPS, effective July 1. -
CMS Public Events: No events this week
There are no public events this week. -
MedicareFind spotlight: NCCI tool updated
With a new quarter comes a new set of NCCI edits. After verifying and testing the updated edit...
Issue 26, June 29, 2010
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Note: Hospitals face three-day payment window changes
President Obama signed legislation on Friday that included a "Clarification of 3-day Payment... -
Regulations: HHS publishes HIT certification rule, CMS releases MPFS proposed rule
On June 25, CMS posted a display copy of its notice of proposed rulemaking for the Medicare... -
Transmittals and MLN Matters articles: CMS releases ICD-10 special edition article, and more
On June 22, CMS posted a special edition MLN Matters article to provide information about ICD-10... -
Other Issuances: Congress clarifies three-day rule
On Friday, President Obama signed the Preservation of Access to Care for Medicare Beneficiaries... -
CMS Public Events: No events this week
There are no public events this week.
Issue 25, June 22, 2010
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Regulations: HHS releases HIT certification rule, CMS posts IPPS corrections
On June 18, HHS released a display copy of the final rule establishing a temporary certification... -
Other Issuances: OIG reviews Part A/Part B bad debts, NGS payments to terminated providers, and more
Do hospitals have to receive imaging accreditation for the Technical Component (TC) of advanced... -
Transmittals and MLN Matters articles: CMS posts drug pricing files, issues special MLN Matters article for IPFs, and more
On June 18, CMS issued a transmittal to implement the October 2010 quarterly average sales price... -
CMS Public Events: No events this week
There are no public events this week.
Issue 24, June 15, 2010
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MedicareFind User's Guide available
MedicareFind subscribers and free trial users can now access the MedicareFind User’s Guide... -
Note: CMS clarifies "immediate availability" and identifies supervisory practitioner qualifications for both diagnostic and therapeutic outpatient hospital services
Last week we discussed CMS’ clarifications regarding supervision requirements for hospital... -
Note: Revised FY2010 Rates and Supplement to FY2011 Proposed Rule
This week CMS issued corrections to a proposed rule and a notice published earlier this month... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS posts online appeal instructions, publishes inflation factor, and more
On June 11, CMS issued a transmittal to provide contractors with the guidelines for accepting... -
Other Issuances: OIG audits bad debts, NCHS posts ICD-9 conversion table, and more
On June 4, the OIG issued two reports on bad debts claimed by Carolinas Medical Center under parts... -
CMS Public Events: Hospital ODF transcript available
MedicareFind subscribers now have access to the written transcript and audio recording of the... -
MedicareFind spotlight: PRRB decisions
MedicareFind users can now access appeals decisions made by the Provider Reimbursement Review... -
MedicareFind spotlight: Press releases and fact sheets
MedicareFind users can now access a comprehensive archive of press releases and fact sheets from...
Issue 23, June 8, 2010
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Note: CMS updates supervision requirements for hospital diagnostic and therapeutic services
In recurring update notification R128BP, CMS has provided additional clarification on the... -
Regulations: CMS IPPS notice, proposals under PPACA
On June 2, CMS published in the Federal Register two entries that would make changes to the IPPS... -
Transmittals and MLN Matters articles: CMS issues supervision guidance, issues NCDs, and more
On May 28, CMS issued the July update to the OPPS for the Benefit Policy Manual, in which it... -
Other Issuances: No releases this week
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Public Events: RAC 101, Physician ODF transcripts available
MedicareFind subscribers can now access the written transcripts of the nationwide RAC 101 call... -
MedicareFind Demonstration Webcast June 16
MedicareFind is changing the way you and your colleagues FIND the regulatory information you need...
Issue 22, June 1, 2010
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Note: Cardiac Rehab and Intensive Cardiac Rehab revisited
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the... -
Regulations: CMS publishes CoP proposal in Federal Register
Regulations: CMS publishes CoP proposal in Federal Register -
Transmittals and MLN Matters articles: CMS instructs on cardiac rehab, issues quarterly updates, and more
Transmittals and MLN Matters articles: CMS instructs on cardiac rehab, issues quarterly updates... -
Other Issuances: FY 2011 ICD-9-CM addenda available, CMS posts corridor width memo
Other Issuances: FY 2011 ICD-9-CM addenda available, CMS posts corridor width memo -
CMS Public Events: No events this week
CMS Public Events: No events this week -
MedicareFind spotlight: Physician supervision Q&A
MedicareFind spotlight: Physician supervision Q&A
Issue 21, May 25, 2010
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Note: Proposed Revisions to the Three-Day Payment Window
The three-day payment window, sometimes known incorrectly as the “72-hour rule,” has... -
Regulations: CMS issues PPACA rulemaking, proposes CoP changes
On May 21, CMS issued display copies of two Federal Register entries that would make changes to... -
Transmittals and MLN Matters articles: CMS issues guidance on "clinical review judgment" to RACs and other auditors
On May 14, CMS issued a transmittal to define “clinical review judgment” and instruct... -
Other Issuances: OIG reviews outpatient payments, CMS posts ICD-10 FAQs
On May 10, the OIG issued a review of payments for outpatient services at Swedish Medical Center... -
CMS Public Events: Hospital Open Door Forum Thursday, RAC 101 call transcript available
The next Hospital & Hospital Quality Open Door Forum is scheduled for Thursday, May 27, 2010... -
MedicareFind tip: How to track health reform updates
The recently enacted Patient Protection and Affordable Care Act (and companion Health Care and...
Issue 20, May 18, 2010
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Note: Opportunity to update Medicare Advantage patient information needed to determine Medicare disproportionate share (DSH) payments for FYs 2007 and 2008 expires August 31, 2010
In transmittal R696OTN published earlier this month, Medicare reminded hospitals of the... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS issues MLN Matters articles on timely filing under PPACA, multiple procedure payment reduction, HIV screening, and more
CMS released several MLN Matters articles related to transmittals previously outlined in Medicare... -
Other Issuances: OIG reviews excessive outpatient claims, and more
CMS has issued revised Addendum A and Addendum B data files to reflect changes under the Patient... -
CMS Public Events: Special Enrollment Open Door Forum Wednesday
CMS will hold a Special Open Door Forum regarding provider and supplier enrollment on Wednesday...
Issue 19, May 11, 2010
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Pulmonary Rehabilitation Services Revisited
CMS finally published two transmittals that provide us with the details we have been waiting... -
Regulations: CMS issues PPACA enrollment rulemaking, publishes IPPS proposed rule
On May 5, CMS published in the Federal Register an interim final rule to implement various... -
Transmittals and MLN Matters articles: CMS issues pulmonary rehab transmittals, implements new timely filing requirements, and more
On May 7, CMS issued transmittals to the Claims Processing Manual and Benefit Policy Manual to... -
Other Issuances: OIG issues reviews of program safeguard contractor overpayments
On May 7, the OIG issued two audit reports on the program safeguard contractors (PSC). The OIG... -
CMS Public Events: RAC 101 transcript available, next call scheduled for Wednesday
The transcript and audio of CMS’ first RAC 101 nationwide call on April 28 is now available...
Issue 18, May 4, 2010
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Note: Clarification on Discarded Drugs
This week CMS issued clarification on a couple of drug billing related issues. In Claims... -
Regulations: CMS publishes IPF PPS update for 2011, OCR asks for information on accounting of disclosures
On May 3, the Office for Civil Rights (OCR) published in the Federal Register a request for... -
Transmittals and MLN Matters articles: CMS instructs on discarded drugs/biologicals, addresses self-administered drugs, and more
On April 30, CMS issued a transmittal to clarify what “administered” means in the... -
Other Issuances: OIG audits outpatient lithotripsy billing, high-dollar claims, and more
On April 19, the OIG issued a review of payments for outpatient lithotripsy services provided at... -
CMS Public Events: RAC 101 calls
This week, CMS continues to hold nationwide RAC education conference calls. -
MedicareFind Forum: Coverage for J9055 Cetuximab
We have received a denial stating: Fraud alert dosage exceeds 90mg. This patient has been...
Issue 17, April 27, 2010
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Regulations: CMS issues 2011 IPPS proposed rule
CMS has posted a display copy of proposed rulemaking under the IPPS for FY 2011. -
Note: FY 2011 inpatient rule has payment reductions for PPS providers, clarification for CAHs
The FY 2011 IPPS proposed rule contains a reduction in the standardized amount reflecting an... -
Transmittals and MLN Matters articles: CMS seeks RAC appeals reports, modifies site verification, and more
On April 23, CMS issued a transmittal instructing affiliated contractors and Medicare... -
Other Issuances: No releases this week
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Public Events: Physician Open Door Forum transcript/audio available
The transcript and audio recording of the April 13 Physicians, Nurses, and Allied Health... -
MedicareFind Spotlight: Condition code 44
Check out our series of MedicareMentor Blog posts on condition code 44.
Issue 16, April 20, 2010
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Note: FAQs updated for changes in MUEs
Note: FAQs updated for changes in MUEs -
Regulations: CMS publishes revisions to Medicare coverage Part C and Part D in Federal Register
Regulations: CMS publishes revisions to Medicare coverage Part C and Part D in Federal Register -
Transmittals and MLN Matters articles: CMS revises several previous transmittals and issues MLN Matters article on Medicare coverage of blood glucose monitors and testing supplies
Transmittals and MLN Matters articles: CMS revises several previous transmittals and issues MLN... -
Other Issuances: President Obama's Continuing Extension Act, OIG reports on medical errors, and FAQs
Other Issuances: President Obama’s Continuing Extension Act, OIG reports on medical errors... -
CMS Public Events: No events this week
CMS Public Events: No events this week
Issue 15, April 13, 2010
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Volunteers needed!
HCPro is seeking a small group of volunteers to participate in MedicareFind user research calls... -
Note: Updates on three day payment window and supervision at CAH hospitals
This week there wasn’t a lot of new information from CMS so I thought I would update you on... -
Regulations: CMS posts 2011 payment policies for Medicare Advantage, prescription drugs
CMS released a display copy of rulemaking containing the capitation rates for Medicare Advantage... -
Transmittals and MLN Matters articles: CMS instructs on patients in custody, issues MLN Matters article on recoupment, and more
On April 9th, CMS issued a transmittal notifying A/B MAC/carriers to continue to pay the technical... -
Other Issuances: Region D RAC updates audit issue description
Health Data Insights, the Region D RAC, has updated its description of an existing audit issue. -
CMS Public Events: Physician Open Door Forum, RAC educational calls, and more
The next Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for... -
MedicareFind Forum: Venous gas sampling
Read more and respond by going to the MedicareFind Forum. To respond, log in using your...
Issue 14, April 6, 2010
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Note: Extension of existing healthcare provisions, including protections for certain rural and other hospitals
Note from the Instructor: Extension of existing healthcare provisions, including protections for... -
Regulations: No issuances this week
Regulations: No issuances this week -
Transmittals and MLN Matters articles: CMS instructs on reasonable cost payment, updates medical conditions list, and more
Transmittals and MLN Matters articles -
Other Issuances: CMS updates lab NCDs, OIG audits overpayments, and more
Other Issuances: NCD coding policy and manual change report, OIG reports on Medicare overpayments... -
CMS Public Events: No events this week
CMS Public Events: No events this week -
MedicareFind spotlight: Quarterly NCCI update
MedicareFind spotlight: Quarterly NCCI update
Issue 13, March 30, 2010
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Note: Appeals council issues a "partially favorable" decision
The Medicare Appeals Council has issued a decision on one of the many outstanding appeals from the... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS instructs on cardiac defibrillator services, affirms PET coverage policy, and more
On March 26, CMS issued a transmittal to update the list of ICD-9-CM diagnosis codes not requiring... -
Other Issuances: RACs update audit issues, OIG audits lab billing, and more
CGI Federal and HealthDataInsights, the RACs for regions B and D, continue to update their... -
CMS Public Events: Rural Health Open Door Forum transcript/audio available
A transcript and audio recording of the March 9 Rural Health Open Door Forum are now available to... -
MedicareFind Forum: Outpatient therapeutic services on date of inpatient discharge
I’ve been trying to locate Medicare regulations to support the billing of outpatient... -
MedicareFind tip: How to locate specific sections of a large document
MedicareFind recently put into place a new feature that assists you in quickly accessing...
Issue 12, March 23, 2010
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Note: Signatures should be audited
In the current regulatory environment there are many contractors that are charged with reviewing... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS revises signature requirements, issues lab coding guidance, and more
On March 19, CMS issued a transmittal to communicate new edit spreadsheets to contractors able to... -
Other Issuances: CMS delays CAH supervision enforcement, RAC updates audit issues, and more
On March 15, CMS issued a notice to Congress that it had instructed its contractors not to evaluate... -
CMS Public Events: ICD-10 provider call March 23
CMS is holding an ICD-10 National Provider Conference Call Tuesday, March 23, from 1–2 pm... -
MedicareFind Forum: Post a question
The MedicareFind Forum is a free resource where you can ask and answer Medicare-related questions... -
MedicareFind tip: How to use the NCCI edit lookup tool
MedicareFind subscribers have access to an NCCI edit lookup tool, updated each quarter with the... -
MedicareFind Demonstration April 6
Join us Tuesday, April 6, to learn more about how MedicareFind™ can help you find the...
Issue 11, March 16, 2010
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Note: Rural Open Door Forum addresses provider concerns with physician supervision
Last Tuesday, March 9, CMS hosted the Rural Health Open Door Forum for rural providers in which... -
Regulations: HHS publishes EHR certification proposal in Federal Register
HHS published its proposed rule on EHR certification programs in the March 10 Federal Register. It... -
Transmittals and MLN Matters articles: CMS to implement expanded ICD-9 processing, revise PTA and cardiac rehab coverage, and more
On March 5, CMS issued a transmittal to implement processing of more ICD-9 codes (diagnosis and... -
Other Issuances: CMS issues lab memo
On March 1, CMS issued a memo to communicate certain revised CLIA interpretive guidelines related... -
CMS Public Events: Hospital Open Door Forum transcript/recording available
A transcript and audio recording of the March 4 Hospital & Hospital Quality Open Door Forum are... -
MedicareFind Forum: Patient status orders
I'm looking for any information on changing patient type orders from Inpatient to Observation... -
MedicareFind tip: How to sort and filter documents
Filtering and sorting are at the heart of the MedicareFind solution. These features make it faster...
Issue 10, March 9, 2010
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Note: Reviewing the three-day rule
Last week during the CMS Hospital Open Door Forum, CMS responded to requests for clarification on... -
Regulations: HHS issues EHR certification program proposal
On March 2, HHS issued a proposed rule regarding the establishment of EHR certification programs... -
Transmittals and MLN Matters articles: CMS updates OPPS, implements HIV screening NCD, and more
On February 26, CMS issued the April 2010 update to the OPPS. The update includes changes to... -
Other Issuances: CMS updates FAQs
CMS posted several new/updated frequently asked questions (FAQ). -
CMS Public Events: Rural Health Open Door Forum March 9
The next Rural Health Open Door Forum is scheduled for Tuesday, March 9, 2010 from 2–3 pm... -
MedicareFind Forum: Broviac catheter infusions
A patient presents to a Hospital Outpatient Infusion Center - How do you code administration for a... -
MedicareFind tip: What to do when you don't know your password
Subscribers and free trial users of MedicareFind may need help resetting a password they’ve...
Issue 9, March 2, 2010
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Note: RAC coding reviews and fraud training
This week several transmittals, including the April quarterly OPPS update, were listed on the... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS web site error, MLN Matters article
Due to an error on the CMS Web site, we are unable to include links and reports on several... -
Other Issuances: RACs update issues, OIG examines RAC fraud referrals, CMS posts OIVIT NCD
CGI Federal and Connolly Healthcare, the RACs for regions B and C, continue to update their lists... -
CMS Public Events: Open Door Forum March 4
CMS will host the next Hospital & Hospital Quality Open Door Forum at 2 pm (Eastern) Thursday... -
MedicareFind spotlight: Patient status, claim review programs
Check out the following two resources for guidance on patient status and information about the... -
MedicareFind Forum: Pulmonary rehab
What is the appropriate revenue code to use for HCPCS code G0424? Medicare is denying revenue code...
Issue 8, February 23, 2010
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Note: Recent OIG audits focus on overpayments due to incorrect reporting of drug units
During the last several months the OIG has been auditing hospital outpatient claims to Medicare for... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS adds payment locality, issues MLN Matters articles
On February 12, CMS issued a transmittal documenting the inconsistency in payment rates for claims... -
Other Issuances: OIG reviews oxaliplatin, issues FMAP report
OIG issues two oxaliplatin reviews On February 5, the OIG issued a report on oxaliplatin billing... -
CMS Public Events: No events this week
There are no events this week.
Issue 7, February 16, 2010
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Note: Carving out procedure time from observation hours
Facilities continue to work on developing efficient processes for carving out procedure time from... -
Transmittals and MLN Matters articles: No issuances this week
CMS issued no significant transmittals or MLN Matters articles affecting hospital billing this week. -
Other Issuances: Region D RAC updates issues
HDI updates approved audit issues HealthDataInsights (HDI), the region D RAC, has updated its list... -
CMS Public Events: No events this week
There are no events this week.
Issue 6, February 9, 2010
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Note: Point of Origin codes revised and deleted
CMS issued Transmittal R1917CP implementing the deletion and revision of certain Point of Origin... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS implements OIVIT NCD, deletes point of origin codes, and more
On February 5, CMS issued a transmittal documenting the new HCPCS codes for 2010 subject to... -
Other Issuances: OIG reviews oxaliplatin billing
OIG reports on hospital’s incorrect coding The OIG released a report documenting a...
Issue 5, February 2, 2010
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Note: CMS revises "incident to" rules relating to hospital diagnostic services
During the past several years, CMS has been revising and refining the “incident to&rdquo... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS instructs on clinical trials, incorporates "compendia" definition into manual system, and more
On January 29, CMS issued a transmittal to change how Medicare systems process revenue code lines... -
Other Issuances: RAC updates issues, CMS releases FAQs on observation, condition code 44, and more
May a hospital report drug administration services, such as therapeutic infusions, hydration... -
CMS Public Events: No events this week
There are no events this week. -
Medicaid Integrity Contractors: We want to hear from you
Has your organization undergone an audit by a Medicaid Integrity Contractor (MIC)? If so, we want...
Issue 4, January 26, 2010
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Note: Changes are on the horizon for critical access hospitals
In the January 12, 2010 issue of Medicare Weekly Update, we mentioned that CMS had issued a memo... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: No issuances this week
CMS issued no significant transmittals or MLN Matters articles affecting hospital billing this week. -
Other Issuances: Audit issues updated for RAC regions B and C, OIG reviews oxaliplatin
Connolly Healthcare, the Region C RAC, and CGI Federal, the Region B RAC, continue to update their... -
CMS Public Events: Hospital Open Door Forum transcript/recording available
A transcript and audio recording of the January 14 Hospital & Hospital Quality Open Door Forum... -
MedicareFind update: Access particular areas of a document quickly
Accessing the documents you need is only half the battle. With rulemaking from the Federal Register...
Issue 3, January 19, 2010
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Note: CMS updates instructions to contractors for requesting CMS' permission to pay claims without first obtaining CWF approval
The Common Working File (CWF), which tracks beneficiary eligibility information, generally must... -
Regulations: CMS, ONC publish EHR rulemaking
On January 13, CMS published in the Federal Register a proposed rule to specify the initial... -
Transmittals and MLN Matters articles: CMS addresses OIG reports, revises previous transmittals, and more
On January 15, CMS released a one-time notification detailing various OIG reports that contain... -
Other Issuances: Region B RAC updates audit issues, CMS releases FAQs
CGI Federal, the Region B RAC, continues to update its list of approved audit issues. -
CMS Public Events: No events this week
There are no events this week.
Issue 2, January 12, 2010
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Note: MUE Denials Allow Appeals
This week CMS reissued a transmittal from December with detailed instructions on contractor... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS corrects NCCI edit files, analyzes inclusion of additional ICD-9 codes on claims, and more
On January 8, CMS issued a transmittal to correct and replace the NCCI edit files it previously... -
Other Issuances: RACs update audit issues, CMS posts NCDs, and more
HealthDataInsights (HDI), the RAC for Region D, and DCS Healthcare, the RAC for Region A, have... -
CMS Public Events: Hospital Open Door Forum
The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday... -
MedicareFind update: NCCI edits updated
New NCCI edits are now available through the MedicareFind NCCI edit lookup tool. MedicareFind...
Issue 1, January 5, 2010
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Regulations: CMS issues OPPS correction, publishes EHR proposed rule, and more
On December 31, CMS published in the Federal Register corrections to the previously issued OPPS... -
Note: New Medicare Part B Services for 2010 - Pulmonary rehabilitation
In the OPPS final rule, it was announced that there would be two new services covered under... -
Transmittals and MLN Matters articles: CMS issues MLN Matters articles
CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare... -
Other Issuances: CMS issues lab NCD manual, Region C RAC updates audit issues
CMS has posted its January 2010 update of the laboratory NCD manual. -
CMS Public Events: No events this week
There are no events this week. -
MedicareFind update: Diagnostic supervision crosswalk
MedicareFind subscribers can now access a new Diagnostic Services Physician Supervision Addendum...