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Medicare Insider

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 Insider

Issue 24, June 18, 2013

• Note from the instructor: OIG report on usage of financial liability "G" modifiers

  The OIG recently released a report on problems with how Medicare contractors process claims with...

• The week in Medicare updates

  This week’s Medicare updates include an annual update of ICD-9-CM, new non-physician...

• Recent Recovery Auditor activity

  Performant, Connolly, and HDI posted new issues. Click the link above to read about the issues and...

• Upcoming events

  CMS will host National Provider calls in June and July, two Open Door Forums next week, and is...

Issue 23, June 11, 2013

• The week in Medicare updates

  This week’s Medicare updates include pass-through payments for CRNA anesthesia services and...

• Recent Recovery Auditor activity

  Performant and Connolly posted new issues. Click the link above to read about the issues and see...

• Upcoming events

  CMS will host National Provider calls in June and July, and is seeking comments on proposed...

Issue 22, June 4, 2013

• Note from the instructor: CMS releases information on the National Physician Payment Transparency Program: Open Payments

  CMS recently issued Special Edition MLN Matters article SE1303, which is designed to inform...

• The week in Medicare updates

  This week’s Medicare updates include quarterly updates to the DMEPOS competitive bidding...

• Recent Recovery Auditor activity

  Performant and HDI posted new issues. Click the link above to read about the issues and see which...

• Upcoming events

  CMS will host National Provider calls in June and July, and is seeking comments on proposed...

Issue 21, May 29, 2013

• TOB 85X Medically Unlikely Edit claims adjudication change

  At this time, CAH Method II providers who received some MUE claim denials for a claim line with a...

• Resource available for CAH II physicians eligible to participate in the Medicare EHR incentive program

  Physicians who assign their reimbursement and billing to a Critical Access Hospital (CAH) under...

• The week in Medicare updates

  This week’s Medicare updates include information on the National Physician Payment...

• Recent Recovery Auditor activity

  Connolly and HDI posted new issues. Click the link above to read about the issues and see which...

• Recent Recovery Auditor activity

  Performant and HDI posted new issues. Click the link above to read about the issues and see which...

• Upcoming events

  CMS will host National Provider calls in June and July, and an Open Door Forum in May. Click the...

Issue 20, May 21, 2013

• Note from the instructor: CMS clarifies payment amount to be applied to payment caps and manual review thresholds for outpatient therapy services provided by critical access hosptials

  In a recent Transmittal (R1216OTN) and related MLN Matters Article (MM8278), CMS clarified that...

• The week in Medicare updates

  This week’s Medicare updates include a requirement for sending immediate advisements to the...

Issue 19, May 14, 2013

• The week in Medicare updates

  This week’s Medicare updates include new HCPCS codes for customized DME, quarterly updates to...

• Recent Recovery Auditor activity

  Connolly posted new issues. Click the link above to read about the issues and see which states are...

• Upcoming events

  CMS will host HCPCS Public Meetings and National Provider calls in May and June, Click the link...

• Applying multiple procedure payment reductions to therapy cap amounts for Critical Access Hospital (CAH) claims

  The American Taxpayer Relief Act of 2012 included provisions affecting the outpatient therapy caps...

Issue 18, May 7, 2013

• Note from the Instructor: Guidance on Implementing Sequestration under the Medicare Fee-for-Service Program

  A number of hospitals and other providers have been asking CMS for additional guidance on the...

• The week in Medicare updates

  This week’s Medicare updates include updated FAQs, and two proposed rules regarding FY2014...

• Recent Recovery Auditor activity

  Performant and Connolly posted new issues. Click the link above to read about the issues and see...

• Upcoming events

  CMS will host HCPCS Public Meetings in May and June, Click the link above for registration...

Issue 17, April 30, 2013

• Note from the instructor: CMS issues proposed IPPS/LTCH rule for FY 2014

  On April 26, CMS issued a proposed rule that would update FY 2014 Medicare payment policies and...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include a proposed rule from CMS on inpatient...

• Recent Recovery Auditor activity

  Performant and Connolly posted new issues, plus news on CMS' plans to restructure the RAC program...

• Upcoming events

  CMS will host a SNF/LTC Open Door Forum  the first week of May, and an HCPCS Public Meeting on...

• Changes for Outpatient Laboratory Services Rendered in a Critical Access Hospital (CAH)

  Patients presenting to Critical Access Hospitals (CAHs) will encounter a change in their...

Issue 16, April 23, 2013

• Note from the instructor: More Changes for Medically Unlikely Edits (MUEs)

  CMS and providers have had a love/hate relationship with Medically Unlikely Edits (MUEs), and are...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include one proposed rule from the OIG on...

• Recent Recovery Auditor activity

  Performant posted new issues. Click the link above to read about the issues and see which states...

• Upcoming events

  CMS will host state-by-state calls in Federally-facilitated and State Partnership Marketplace...

Issue 15, April 16, 2013

• Note from the instructor: CMS releases additional guidance on Part A to B rebilling

  CMS has released several documents regarding the rule change that allows for full Part B payment...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include two proposed rules: one from the OIG...

• Recent Recovery Auditor activity

  Performant Recovery, CGI, and Connolly all posted new issues. Click the link above to read about...

• Upcoming events

  CMS will host state-by-state calls in Federally-facilitated and State Partnership Marketplace...

Issue 14, April 9, 2013

• Note from the instructor: CMS continues to provide updates on the Medicare and Medicaid EHR Incentive Programs

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• The week in Medicare updates

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• Recent Recovery Auditor activity

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• Upcoming events

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Issue 13, April 2, 2013

• Note from the instructor: Manual medical review by Recovery Auditors of outpatient therapy claims begins April 1

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• The week in Medicare updates

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• CMS issues final rule on requirements for LTC facilities notices of closure

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• Recent Recovery Auditor activity

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• Upcoming events

  CMS will hold three national provider calls in April. Click the link above to learn more!

Issue 12, March 26, 2013

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

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

• The week in Medicare updates

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

• Medicare Audit Improvement Act reintroduced, AHIMA shows support

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

• Recent Recovery Auditor activity

  Performant Recovery, CGI, and Connolly all have newly added Recovery Auditor issues, including...

• Upcoming events

  CMS will hold two national provider calls in April on the Medicare Shared Savings Program. Click...

Issue 11, March 19, 2013

• CMS issues proposed changes to Part B inpatient billing in hospitals

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

• Important Medicare Updates

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

• CMS instructs on Taxpayer Relief Act and sequestration impact on CAHs

  During the March 7 Rural Health Open Door Forum, CMS discussed a number of items that have an...

• Recent Recovery Auditor Activity

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

• Upcoming events

  CMS will hold open door forums on March 19 (Ambulance) and March 21 (Skilled nursing...