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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 2, January 14, 2014

• Upcoming events

  CMS is hosting National Provider calls and Open Door Forums this week. Click the link above for...

Issue 29, July 22, 2014

• Note from the instructor: Reimbursement for outpatient services provided to critical access hospital (CAH) patients

  This week’s note is about CAH reimbursement for outpatient services. Click the link above for...

• The week in Medicare updates

  This week’s updates include national coverage determination for cardiac pacemakers and...

• Upcoming events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

Issue 28, July 15, 2014

• Note from the instructor: CMS Updates Medically Unlikely Edits (MUE) File

  This week’s note is about medically unlikely edits. Click the link above for more information...

• The week in Medicare updates

  This week’s updates include proposed changes to the Physician Value-based Modifier and...

• Upcoming events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

Issue 27, July 8, 2014

• Note from the instructor: CY 2015 OPPS Proposed Rule contains Significant Policies

  This week’s note is about the CY 2015 OPPS Proposed Rule. Click the link above for more...

• The week in Medicare updates

  This week’s updates include CY 2015 proposed rules for home health, OPPS, and Medicare...

• Upcoming Events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

• Product Spotlight

  Announcing the Sixth Annual Medicare Compliance Forum! Orlando, Florida – October 23 and...

Issue 26, July 1, 2014

• Note from the instructor: CMS? Advisory Panel on Hospital Outpatient Payment seeks input on chemotherapy supervision rules

  This week’s note is about chemotherapy supervision rules. Click the link above for more...

• The week in Medicare updates

  This week’s updates include clarification to home health benefit billing instructions and a...

• Upcoming Events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

• Product Spotlight

  Don’t miss your chance to register for our popular upcoming Medicare Boot...

Issue 25, June 24, 2014

• Note from the instructor: CMS Updates Special Edition Article on the Proper Use of Modifier -59

  This week’s note is about modifier -59. Click the link above for more information and an...

• The week in Medicare updates

  This week’s updates include extension of the payment adjustment for certain hospitals and...

• Upcoming events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

• Product spotlight

  Due to popular demand, we’ve added another Medicare Boot Camp—Utilization Review...

Issue 24, June 17, 2014

• Note from the instructor: Reimbursement for outpatient services provided to critical access hospital patients

  This week’s note is about critical access hospital payments. Click the link above for more...

• The week in Medicare updates

  This week’s updates include an update to the Medicare Physician Fee Schedule Database and...

• Recent Recovery Auditor activity

  There has been no recent recovery auditor activity.

• Upcoming Events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

• Product Spotlight

  Due to popular demand, we’ve added another Medicare Boot Camp—Utilization Review...

Issue 23, June 10, 2014

• Note from the instructor: CMS Releases Guidance on Modifier L1 and Clarifies Lab Payment for TOB 12X

  This week’s note is about laboratory billing and payment. Click the link above for more...

• The week in Medicare updates

  This week’s updates include revisions to the Program Integrity Manual and updated data on...

• Recent Recovery Auditor activity

  There has been no recent recovery auditor activity.

• Upcoming events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

Issue 22, June 3, 2014 - VIEW THE FULL ISSUE

• Note from the instructor: CMS releases proposed FY 2015 Inpatient Prospective Payment System (IPPS) payment adjustments, Part III

  This week’s note is about FY 2015 IPPS proposed payment adjustments. Click the link above...

• Recent Recovery Auditor activity

  There has been no recent recovery auditor activity.

• Upcoming events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

Issue 21, May 27, 2014

• Note from the instructor: CMS releases proposed FY 2015 Inpatient Prospective Payment System (IPPS) payment adjustments, Part II

  This week’s note is about FY 2015 IPPS proposed payment adjustments. Click the link above for...

• The week in Medicare updates

  This week’s updates include an update to surety bond collection procedures and changes to the...

• Recent Recovery Auditor activity

  HDI posted one new issue in one category.

• Upcoming events

  CMS is hosting open door forums in the upcoming months. Click the link above for registration...

• Product spotlight

  Due to popular demand, we’ve added another Medicare Boot Camp—Utilization Review...

Issue 20, May 20, 2014

• Note from the instructor: CMS releases proposed FY 2015 IPPS payment adjustments, Part I

  This week’s note is about Inpatient Prospective Payment System FY 2015. Click the link above...

• Note from the instructor: CMS releases proposed FY 2015 IPPS payment adjustments, Part I

  This week’s note is about Inpatient Prospective Payment System FY 2015. Click the link above...

• The week in Medicare updates

  Teaser: This week’s updates include the announcement of the Advisory Panel on Hospital...

• Recent Recovery Auditor activity

  HDI posted one new issue in one category.

• Upcoming events

  CMS is hosting an open door forum this week. Click the link above for registration information.

• Product spotlight

  2014 Sixth Annual Medicare Compliance Forum

Issue 19, May 13, 2014

• Clarification of Two CMS Transmittals ? Devices and Anesthesiologist/CRNA Payments

  In the Medicare Claims Processing Transmittal 2903, April 2014 Update of the Hospital Outpatient...

• The week in Medicare updates

  This week’s updates include an update to CMS Publication and an update for clinical...

• Recent Recovery Auditor activity

  There are no new RAC issues this week.

Issue 18, May 6, 2014

• Note from the instructor: AHA files two lawsuits related to the 2-midnight rule; Still a rule in turmoil

  This week’s note is about AHA lawsuits related to 2-midnight rule. Click the...

• The week in Medicare updates

  This week’s updates include Medicare Part B Drug Pricing Files and an update to the State...

• Recent Recovery Auditor activity

  CGI posts two new issues in one category. Click the link for more information.

Issue 17, April 29, 2014

• Note from the instructor: CMS reassigns packaged skin substitute products approved for payment in CY 2014 based upon updated payment information

  This week’s note is about coding, billing, and payment for skin substitute products. Click...

• The week in Medicare updates

  This week’s updates include clarification to the Medicare Benefit Policy Manual and a...

• Recent Recovery Auditor activity

  There has been no recent recovery auditor activity.

• Upcoming events

  There are two National Provider calls coming up in May. Click the link above for registration...

Issue 16, April 22, 2014

• The week in Medicare updates

  This week’s updates include payment change request to extend coverage of the oral antiemetic...

• Recent Recovery Auditor activity

  There has been no recent recovery auditor activity.

• Upcoming events

  CMS is hosting an open door forum this week. Click the link above for registration information.

Issue 15, April 15, 2014

• Note from the instructor: CMS clarifies billing guidelines on proper billing for drugs in a single-dose or single-use vial, including billing for discarded drugs

  This week’s note is about updated CMS guidelines for proper billing of discarded outpatient...

• The week in Medicare updates

  This week’s updates include updates to the Medicare Claims Processing Manual, the Hospice...

• Recent Recovery Auditor activity

  CGI posted one new issue to its CMS approved list for providers. Click the link above to read about...

• Upcoming events

  HCPro is hosting a live webcast in April. Click the link above for registration information.

• Medicare Boot Camp - Utilization Review Version

  NEW COURSE ADDED! Seattle — May 19–20 Medicare Boot Camp—Utilization Review...

Issue 14, April 8, 2014

• Note from the instructor: Hospital Outpatient Payment Panel makes recommendations to CMS

  Click the link above for more information and an in-depth analysis.  ...

• The week in Medicare updates

  This week’s updates include a comment period for proposed changes to certain current...

• Recent Recovery Auditor activity

  CGI posted one new issue to its CMS approved list for providers, and Connolly posted two new issues...

• Upcoming events

  HCPro is hosting a live webcast in April. Click the link above for registration information.

Issue 13, April 1, 2014

• Note from the instructor: As the healthcare world turns...

  Click the link above for more information and an in-depth analysis.  

• The week in Medicare updates

  This week’s updates include several reports from the OIG regarding incorrect CMS payments...

Issue 12, March 25, 2014

• The week in Medicare updates

  This week’s updates include updated conditions of participation guidance on medication...

• Upcoming events

  HCPro is hosting a live webcast and CMS is hosting a National Provider Call in April. Click the...

Issue 11, March 18, 2014

• The week in Medicare updates

  This week’s updates include modifications to the Daily Common Working File and updates to...

• Recent Recovery Auditor activity

  Connolly posted two new issues and CGI posted one new issue. Click the link above to read about...

• Upcoming events

  CMS is hosting one National Provider Call in March and one National Provider Call in April. Click...

• Medicare Boot Camp® - Utilization Review Version

  Medicare Boot Camp®—Utilization Review Version NEW COURSE ADDED! Seattle &mdash...

Issue 10, March 11, 2014

• Note from the instructor: Update on laboratory billing: new 2-midnight guidance

  Click the link above for more information and an in-depth analysis.  

• The week in Medicare updates

  This week’s updates include the April 2014 update of the hospital outpatient prospective...

• Recent Recovery Auditor activity

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

• Upcoming events

  CMS is hosting two Open Door Forums and two National Provider Calls in March. Click the link above...

• Medicare Boot Camp® - Utilization Review Version

  Don’t leave money on the table! Medicare Boot Camp® - Utilization Review Version is an...

Issue 9, March 4, 2014

• Note from the instructor: Billing Outpatient Laboratory Services - TOB 131 vs. TOB 141

    Click the link above for more information and an in-depth analysis.    

• The week in Medicare updates

  This week’s updates include a change request to implement compliance with NACHA operating...

• Recent Recovery Auditor activity

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

• Upcoming events

  CMS is hosting two Open Door Forums and two National Provider Calls in March. Click the link above...

Issue 8, February 25, 2014

• The week in Medicare updates

  This week’s updates include an MLN Matters Special Edition article to convey CMS&rsquo...

• Recent Recovery Auditor activity

  Connolly posted three new issues in three categories and CGI posted two new issues. Click the link...

• Upcoming events

  CMS is hosting two National Provider calls in February. Click the link above for registration...

Issue 7, February 18, 2014

• The week in Medicare updates

   This week’s updates include updates to the Medicare Claims Processing Manual, Reporting...

• Recent Recovery Auditor activity

  Performant Recovery posted new issues to its CMS approved list for providers. Click the link above...

• Upcoming events

  CMS is hosting two Open Door Forums and two National Provider calls in February. Click the link...

• Medicare Boot Camp® - Utilization Review Version

  Don’t leave money on the table! Medicare Boot Camp® - Utilization Review Version is an...

Issue 6, February 11, 2014

• Note from the instructor: OIG releases FY 2014 Work Plan

  We are four months into the new fiscal year and the Office of Inspector General (OIG) has finally...

• The week in Medicare updates

  This week’s updates include the updated OIG Work Plan, changes to the laboratory NCD software...

• Recent Recovery Auditor activity

  Performant Recovery posted new issues to its CMS approved list for providers. Click the link above...

• Upcoming events

  CMS is hosting two National Provider calls in February. Click the link above for registration...

• Medicare Boot Camp® - Utilization Review Version

  Don’t leave money on the table! Medicare Boot Camp® - Utilization Review Version is an...

• Hospital inpatient admission order and certification

  CMS has released additional clarification on the provisions of the 2014 IPPS Final Rule regarding...

Issue 5, February 4, 2014

• Note from the instructor: Extension of probe and educate audits; new guidance on inpatient orders by residents and ED docs

  On January 31, CMS announced on its Inpatient Hospital Reviews website that it extended the probe...

• The week in Medicare updates

  This week’s updates include probe reviews of inpatient hospital claims and corresponding...

• Recent Recovery Auditor activity

  Performant Recovery and Connolly posted new issues to its CMS approved list for providers. Click...

• Upcoming events

  CMS is hosting an Open Door Forum and a National Provider call in February. Click the link above...

• Medicare Boot Camp® - Utilization Review Version

  Don’t leave money on the table! Medicare Boot Camp® - Utilization Review Version is an...

Issue 3, January 21, 2014

• Note from the instructor: Lab billing details in the January 2014 OPPS update

  Last week, CMS released MLN Matters article MM8572 with billing instructions for laboratory...

• Note from the instructor: CMS issues guidance to implement calendar year 2014 outpatient changes

  In this week’s note, we will take a closer look at RUN transmittal R2845CP and related MLN...

• The week in Medicare updates

  This week’s updates include the January 2014 update of the Hospital Outpatient Prospective...

• The week in Medicare updates

  This week’s updates include registration of entities using the Indirect Payment Procedure...

• Recent Recovery Auditor activity

  No new items this week.

• Recent Recovery Auditor activity

  Performant Recovery posted one new issue to its CMS approved list for providers. Click the link...

• Upcoming events

  CMS is hosting a National Provider call in February. Click the link above for registration...

• Upcoming events

  CMS is hosting a National Provider call and an Open Door Forum in February. Click the link above...

• Medicare Boot Camp® - Utilization Review Version

  This Medicare primer goes beyond the 2-midnight rule by showing you the big picture on how the new...

• Medicare Boot Camp® - Utilization Review Version

  Don’t leave money on the table! Medicare Boot Camp® - Utilization Review Version is an...

Issue 2, January 14, 2014

• The week in Medicare updates

  This week’s updates include corrections to the hospital IPPS for acute care hospitals, the...

• Note from the instructor: 2-Midnight Rule clarifications continue

  As we await more instructions from CMS on implementation of the OPPS and MPFS final rule, I thought...

• Recent Recovery Auditor activity

  CGI posted new item to its CMS approved list for providers. Click the link above to read about the...

• CAH Method II overpayments related to the Annual Wellness Visit

  In July 2013, Medicare Administrative Contractors (MACs) began to recover overpayments on Annual...

Issue 1, January 8, 2014

• Note from the instructor: Confusion about device and procedure edits

  In the OPPS proposed rule, CMS had proposed to do away with the device to procedure and procedure...

• The week in Medicare updates

  This week’s updates include a final rule revising the exception on the physician...

• Recent Recovery Auditor activity

  Performant Recovery and HealthDataInsights posted new items to their CMS approved lists for...

• Join us on the podium at the 2014 Medicare Compliance Forum

  We are currently seeking speakers to present at the 2014 Medicare Compliance Forum to be held...

• Upcoming events

  CMS is hosting National Provider calls in January and February. Click the link above for...

Issue 51, January 2, 2014

• Note from the instructor: CMS updates Integrated Outpatient Code Editor (IOCE) to incorporate calendar year 2014 outpatient changes

  CMS issues certain quarterly updates relating to hospital outpatient services.These updates are...

• The week in Medicare updates

  This week’s updates include a final rule revising the exception on the physician...

• Recent Recovery Auditor activity

  No new items this week.

• Upcoming events

  CMS is hosting National Provider calls in January and February. Click the link above for...