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Displaying records 1 to 20 out of 7890 results for "medicare managed care".
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SORT RESULTS BY: RELEVANCY | PUBLICATION DATE
  Medicare Managed Care Appeals & Grievances
Q: If a patient is discharged to a behavior management unit that is hospital-b
AM0150 would be answered “2”—Medicare (HMO/managed care/Advantage plan).
We are a Medicare/Medicaid certified agency. We currently have a client who is homebound
The 2015 Medicare Compliance Forum features a robust line-up of topics and speakers to address th
The 2015 Medicare Compliance Forum features a robust line-up of topics and speakers to address th
The 2015 Medicare Compliance Forum features a robust line-up of topics and speakers to address th
With APRNs providing an increased proportion of primary care in the U.S., experts are calling to
JUNE 28, 2018
Beginning January 1, 2015, Medicare began to pay separately under the Medicare Physician Fee Sche
DECEMBER 13, 2016
  Navigating Medicare Advantage: MAOs and Protecting Reimbursement in Long-Term Care
FEBRUARY 24, 2017
  Should traditional Medicare cover chronic care?
HCPro's Medicare Boot Camp®–Long-Term Care Version cover
HCPro's Medicare Boot Camp®–Long-Term Care Version cover
President's FY 2016 Budget Includes Medicare Provisions On F
Physician practices are under increasing financial pressure, and Medicare accounts for a l
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
What this agency heard is in error and could lead to denials. Just as with any Medicare-covered s
  Accounting for Medicare A coinsurance from Medicaid or Managed Medicaid bad debt
AUGUST 2, 2017
On August 25, 2015, The Centers for Medicare & Medicaid Services issued 2014 quality a
AUGUST 28, 2015
Medicare and commercial accountable care organization (ACO) models are not created alike.
FEBRUARY 21, 2017
  Care Plans and Medicare Payments: Why care plans must move toward functionality
CMS announces final regulatory changes affecting Medicare Parts C and D
AUGUST 1, 2014
November marks Home Care and Hospice month, according to CMS. Now is the time to ensure your comm
A new study by the American Journal of Managed Care finds that Medicare Advantage (MA) beneficia
When will the Medicare trust funds run out? That depends on who you talk to. According to
APRIL 27, 2018
The Centers for Medicare & Medicaid Services (CMS) is 
Blogs from industry experts in healthcare that keep users up-to-date on the latest happenings in their fields.
Physician practices are under increasing financial pressure, and Medicare accounts for a l
Medicare Advantage Q&A with Diane Brown QWe have chro
FEBRUARY 1, 2015
Affordable Care Act Accountable Care Organization initiatives put patients at the center of thei
AUGUST 26, 2016
  Medicare Makes Enhancements to the Shared Savings Program to Strengthen Incentives for Qualit
  Dementia Care Added to Medicare Advantage Value-Based Insurance Design Model
DECEMBER 22, 2016
  Obstructing audits could lead to Medicare exclusion for long-term care facilities
MARCH 17, 2017
  Post-Acute Care Has a Quality Management Problem
  Understanding and Promoting the Value of Chronic Care Management Services
JANUARY 27, 2017
  Optimizing Managed Care Partnerships to Maximize Clinical Outcomes
MARCH 16, 2018
On June 25, CMS posted a fact sheet about the Accountable Care Organization (ACO) Investment Mo
On June 6, 2016 the Centers for Medicare & Medicaid Services (CMS) released a final rule imp
It’s the second year for Medicare/Medicare-Fee-for-Service-Pay
MARCH 15, 2016
On September 1, CMS published MLN Matters 9815 to supplement CMS Medicare Financial Management Tr
SEPTEMBER 18, 2017
The Joint Commission (TJC) is seeking comment on a proposed Environment of Care (EC) standard set
OCTOBER 8, 2020
The MCBS 2013 Access to Care public use file (MCBS PUF) provides the first publicly available MC
To ensure hospitals are up to date on important Medicare regulatory issues in light of increased
JULY 13, 2011
On March 8th, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule t
MARCH 11, 2016
On August 9, the Centers for Medicare & Medicaid Services (CMS) released a new analysis demo
AUGUST 12, 2016
The growth of managed care continues to grow due to the Medicaid expansion under the Affordable C
OCTOBER 24, 2014
The following is an excerpt from our new book, managing-complex
The Office of the Inspector General (OIG) released its top management and performance challenges
New Bill Would Expand Insurance for Home Care   A bill intro
Medicare doesn’t differentiate between skilled and unskilled personal care because there is
This week’s updates include Focused Dementia Care survey tools; a 0.2% reduction in IPP
This week’s updates include changes to the FY 2016 IPPS and long-term care hospital (LT
Agencies should consider implementing a Utilization Review (UR) model or a clinical manager as a
The use of “Observation Status” – treating certain hospitalized Medicare patien
AUGUST 21, 2014
Quarterly ASP Medicare Part B drug pricing files released On April 25,
Clarification to Pub. 100-02, Medicare Benefit Policy Manual Regarding Antigens
In response to the ever-changing regulatory and payment landscape of the long-term care and hom
FEBRUARY 26, 2010
On August 18, 2016, The Centers for Medicare & Medicaid Services (CMS) issued a request for
AUGUST 19, 2016
Medicare usage all over the map The CMS Office of Minority Healt
Q: When does Medicare consider a wound as chronic/nonhealing and no longer
On August 4th, the Centers for Medicare & Medicaid Services (CMS) announced the participants
AUGUST 5, 2016
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
DECEMBER 27, 2016
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
DECEMBER 13, 2016
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
Medicare regulations are constantly evolving. Get updates on all areas of the Medicare process an
SEPTEMBER 4, 2014
  Managed care admissions: Bridging the communication gap between admissions and the business o
Case managers today have to know a lot. They not only need the skill to work with patients
On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule
APRIL 22, 2016
Bolster billing compliance: Implement a Medicare Part A triple-check process
AUGUST 1, 2015
This week, Medicare officials announced the creation of 121 new accountable care organizations (
JANUARY 14, 2016
Medicare recently announced the creation of a new accountable care payment model, which asks prov
An estimated 30% of Medicare payments are now tied to alternative payment models that reward the
The Centers for Medicare & Medicaid Services (CMS) today issued final regulations for the Med
The Centers for Medicare & Medicaid Services (CMS) released final Medicare Advantage (MA) and
APRIL 17, 2015
Despite a recent movement to increase primary care physicians’ ability to identify mental
Centers for Medicare & Medicaid Services (CMS) announces through its acting administra
You won’t find any mention in the Medicare coverage criteria about chronic or nonhealing wo
Federal lawmakers have introduced a bill designed to improve coordination of care and serv
Long-term care providers will be able to appeal certain Medicare claims decisions without
On September 21, 2015, the Centers for Medicare & Medicaid Services (CMS) announced
SEPTEMBER 25, 2015
  In a report produced jointly by the Medicare Payment Advisory Commission and the
JANUARY 30, 2015
Medicare regulations are constantly evolving. Get updates on all areas of the Medicare pro
APRIL 24, 2015
Medicare regulations are constantly evolving. Get updates on all areas of the Medicare pro
APRIL 17, 2015
  Medicare regulations are constantly evolving. Get updates on all areas of the Me
MARCH 27, 2015
  Medicare regulations are constantly evolving. Get updates on all areas of the Me
MARCH 20, 2015
  Medicare regulations are constantly evolving. Get updates on all areas of the Me
MARCH 13, 2015
  Medicare regulations are constantly evolving. Get updates on all areas of the Me
Medicare regulations are constantly evolving. Get updates on all areas of the Medicare pro
CMS releases July 2014 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files
Improve your plans to manage the spread of pathogenic biological substances such as Legionella be
DECEMBER 4, 2017
On June 15, the Medicare Payment Advisory Commission (MedPAC) releases its June 2016 Report to t
Clarification to Medicare Benefit Policy Manual regarding antigens and deletion of Sect
While most analysts agree that any substantial changes to the Affordable Care Act (ACA) are unlik
Medicare may verify that the provider claims (physician office claims) contain the appropriate bi
We are seeking a Medicare Regulatory Specialist for HCPro-BLR Healthcare to teach our Medicare B
Combining Medicare Boot Camp®—Physician Services Version and Evaluation & Managemen
Combining Medicare Boot Camp®—Physician Services Version and Evaluation & Managemen
This week’s updates include Advance Care Planning (ACP) as an optional element of an An
How many case managers and visit nurses do you recommend per clinical manager?
A recent study published in Health Affairs found that when physician practices have care-manageme
MARCH 31, 2016
by Roy Edroso A sweeping new Medicare enrollment final rule with comment period
Physician practices are under increasing financial pressure, and Medicare accounts for a large po
Last Tuesday, CMS announced a forthcoming model to expand its accountable care organization (ACO)
The first event: The patient chooses to transfer from traditional Medicare to a Medicare Advanta
OIG acting deputy inspector general testifies about Medicare mismanagement
The Centers for Medicare & Medicaid Services (CMS) announced a six-month extension of a state
On September 18, CMS published revised MLN Matters 9815, which accompanies Medicare Financial Man
Third quarter 2015 notice of new interest rate for Medicare overpayments and underpayments pos
If a patient switches from traditional Medicare to MA, the agency will receive a partial episode
The National Association of Home Care & Hospice is following how the presidential election wi
CMS released Medicare-Learning-Network-MLN/ML
CMS has reversed its stance requiring Medicare Advantage (MA) plans to apply Medicare fee-for-ser
Today, the Centers for Medicare & Medicaid Services (CMS) announced two initiatives to
OCTOBER 9, 2014
CMS issued its final rule, Fiscal Year 2020 Payment and Policy changes for Medicare Skilled Nursi
NOVEMBER 15, 2019
The SNF value-based purchasing (VBP) program began adjusting Medicare payments a little over a ye
FEBRUARY 7, 2020
By John Commins (jcommins@healthleadersmedia.com) Centers for Medicare &
APRIL 19, 2020
Hyperbaric oxygen (HBO) therapy is used to treat a variety of conditions, including wound care. H
APRIL 2, 2014
JUSTCODING
On June 2, CMS issued a new Medicare/Provider-Enrollment-and-Certifi
  On Thursday, CMS released a final rule updating the Medicare Shared Savings Prog
Under current Medicare rules, patients can only get coverage for a stay in a skilled nursing faci
NOVEMBER 24, 2015
On the heels of the 49th anniversary of the signing of Medicare and Medicaid into
Nearly one in five Medicare patients fall prey to medically related injuries unrelated to their u
CMS reports that between 2012 and 2015, accountable care orga
AUGUST 30, 2016
CMS releases the Medicare fee-for-service 2013 improper payments report
FEBRUARY 1, 2015
The Acute Hospital Care At Home program will help health systems and hospitals manage inpatie
DECEMBER 3, 2020
CMS extends Medicare home health moratorium   CMS has exten
The American Diabetes Association (ADA) released new guidelines that address diabetes management
FEBRUARY 5, 2016
Patients of the Medicare-certified agency who are under the care of a physician and receiving hom
Q: Over holiday, we received written hospice referral from a physician. Start of care (SO
The Centers for Medicare and Medicaid Services (CMS) has given Detroit Medical Center’s (DM
APRIL 2, 2019
  Medicare Shared Systems modifications necessary to capture various HIPAA comp
Medicare Shared Systems modifications necessary to capture various HIPAA-compliant fields
The Independence at Home Demonstration, which is affiliated with the Affordable Care Act, is maki
SEPTEMBER 20, 2016
A good water management plan begins with your facilities management team and a solid risk assessm
NOVEMBER 1, 2018
Long-term care and other providers could be facing unfair burdens due to ineffective government o
AUGUST 14, 2014
According to a recent report to Congress, OIG estimates that Medicare could have saved bil
MARCH 20, 2015
An unlicensed physician has been convicted for his role in a scheme to bill Medicare for h
FEBRUARY 12, 2015
In its first two years, Medicare’s Pioneer ACOs reported savings of $384 million, and pati
Evaluation and management (E/M) services payments—the principal payment method for physicia
The Recovery Audit Program’s mission is to identify and correct Medicare improper pay-ments
FEBRUARY 1, 2019
Humana says its data shows that accountable care is making a difference for Medicare Advantage be
FEBRUARY 3, 2015
Strategies for Nurse Managers is now on
MAY 19, 2016
 A proposed new emergency management
JUNE 5, 2014
The Center for Medicare and Medicaid Service (CMS) released a new core measure that mandates evi
FEBRUARY 2, 2017
Teaching and training plays a significant role in homecare and is addressed in the Medicare B
A one-size-fits-all approach to case management and patient care can be detrimental to patients a
OCTOBER 19, 2017
Starting in October, 2,592 hospitals will receive lower payments for Medicare patients due to pen
AUGUST 6, 2015
Medicare Trustees Report shows continued slow cost growth On July 22, C
Medicare Trustees Report shows continued slow cost growth On July 22, CM
Trustees’ report shows Medicare solvent to 2030  
CMS announced proposed changes to the Medicare long-term care requirements that would reform &ldq
SEPTEMBER 6, 2019
On May 3, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a final rule (
Unfortunately, one of the most commonly cited deficiencies in home health care is the failure to
Challenges related to Medicare’s Merit-based Incentive Payment System (MIPS) top the list o
SEPTEMBER 25, 2017
The College of Healthcare Management Executives (CHIME) considers the Merit-Based Incentive Payme
Case managers may not be physicians, but they are integral to the quality of patient care.
The Joint Commission revised the rationale to Provision of Care standard PC.01.02.07, which discu
NOVEMBER 4, 2014
Long-term care providers who obstruct audits soon could have their Medicare and Medicaid c
Don’t leave money on the table! Master Medicare rules for reimbursement with the
Don’t leave money on the table! Master Medicare rules for reimbursement with the
Don’t leave money on the table! Master Medicare rules for reimbursement with the
Don’t leave money on the table! Master Medicare rules for reimbursement with the
  Don’t leave money on the table! Master Medicare rules for reimbursement
Don’t leave money on the table! Master Medicare rules for reimbursement with the
Don’t leave money on the table! Master Medicare rules for reimbursement with the
  Don’t leave money on the table! Master Medicare rules for reimbursement
Federal officials announced an accelerated effort to use payment reform to shift Medicare and the
Deborah Collum, national director of revenue cycle management for Covenant Retirement Communities
NOVEMBER 9, 2018
The OIG has taken aim at improper home health Medicare billing in its 2017 Work Plan, which is ba
Yes, Medicare will cover two visits if two individuals are needed to perform a covered service.
The Centers for Medicare & Medicaid Services (CMS) is proposing new regulations that implemen
Managing resident pain is an important aspect of care in any skilled nursing facility (SNF), but
JANUARY 17, 2020
The release of the final rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACR
The Hospital Case Management Orientation Manual is a comprehensive resource that
The Hospital Case Management Orientation Manual is a comprehensive resource that
The Hospital Case Management Orientation Manual Guide is a comprehensive resource that s
FEBRUARY 24, 2015
The Hospital Case Management Orientation Manual Guide is a comprehensive resource
FEBRUARY 10, 2015
The Hospital Case Management Orientation Manual is a comprehensive resource that
The Hospital Case Management Orientation Manual is a comprehensive resource that
The Hospital Case Management Orientation Manual is a comprehensive resource that
The Hospital Case Management Orientation Manual is a comprehensive resource that supplem
The Hospital Case Management Orientation Manual is a comprehensive resource that supplem
The Hospital Case Management Orientation Manual is a comprehensive resource that supplements of i
SEPTEMBER 1, 2015
The Hospital Case Management Orientation Manual is a comprehensive resource that supplem
DECEMBER 1, 2015
The Hospital Case Management Orientation Manual is a comprehensive resource that supplem
DECEMBER 15, 2015
According to a recent report to Congress, OIG estimates that Medicare could have saved bil
MARCH 13, 2015
What are the home health CMS & the Medicare/Medicaid Policy for PTA supervision by a
U.S. Senators Susan Collins (R-ME) and Ben Cardin (D-MD) introduced the Home Health Care Planning
Q: Some of our care teams are having trouble working together—one of my st
Psychiatric patients present a unique set of challenges regarding admission and management in a h
Home health patients with chronic, complex conditions present care coordination challenges that a
Q: Does the CARES Act apply to both Medicare and Medicaid payors? A: Th
The value modifier (VM) is Medicare’s physician pay-for-performance program that rewards or
Auditing Evaluation and Management Services, Second Edition, will help
DECEMBER 29, 2015
  The CMS EHR Incentive Program 2014 attestation deadlines for Medicare-eligible h
The Centers for Medicare and Medicaid Services (CMS) has taken another step toward ensuring tha
NOVEMBER 13, 2015
  Introducing Medicare Compliance Watch and Medicare Insider Daily!
SEPTEMBER 22, 2015
  Traditional Medicare vs. Medicare Advantage Q&A
FEBRUARY 24, 2017
  Teaching hospitals cannot factor in research that isn’t patient-care relat
SEPTEMBER 5, 2014
The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health
The following is expert advice from medicare-audits-surviva
AUGUST 24, 2018
Q&A: Long-term care ICD-10 coding specifics Editor's
JANUARY 1, 2015
Home care study shows checklist possible aid in providing attention to condition changes
The Centers of Medicare & Medicaid Services (CMS) has released a new public data set, the Hom
How stable is the Medicare Advantage program? On July 24, th
OCTOBER 1, 2014
On April 16, 2015, the Centers for Medicare & Medicaid Services (CMS) introduced star
APRIL 17, 2015
Can we provide two home health aides to provide care for a quadriplegic patient?
If you’re a Medicare or Medicaid provider, the Centers for Medicare & Medicaid Services
The ABN (CMS-R-131) is a written notice that the agency must provide to a PPS Medicare-eligible b
With Medicare spending projected to grow to $1.4 trillion by 2027, the federal government is look
SEPTEMBER 4, 2017
The Centers for Disease Control and Prevention (CDC) has released interim guidance for managing o
Nurse managers are key players in implementing and integrating evidence-based practice (EBP) at t
JANUARY 8, 2020
  The week in Medicare updates
  This week in Medicare updates
SEPTEMBER 22, 2015
  The week in Medicare updates
ave added several circumstances that identify Medicare as a secondary payer (MSP). This means Med
2015 HomeCare Elite Winners Announced National Research Corporation and D
The medicare/medicare-fee-for-service-payment/physicianfeedbackprogr
Long-term care providers should have jumped on the Quality Assurance Performance Improvement (QAP
On April 14, 2016, the Centers for Medicare & Medicaid Services (CMS)  announced its la
APRIL 15, 2016
CMS aims to develop and implement two Transfer of Health (TOH) Information and Care Preferences q
CMS has released a proposal to strengthen the Shared Savings Program for Accountable Care Organiz
Fill in the blank: Patients are to be informed about unanticipated outcomes of care by
JUNE 10, 2014
Patients eligible for chronic care management services (CPT code 99490) are generally chronically
Medicare Boot Camp®—Utilization Review Version  
Months after NAHC had sued Medicare regarding the face-to-face requirement under the Affordable
 CDC looks at the current state of the long-term care industry
The 21% "negative update" in Medicare reimbursement for physicians mandated by the Sust
It’s finally here—the week to celebrate all things case management and raise awarenes
OCTOBER 13, 2015
Medicare myths Editor's note: This article is excerpted f
AUGUST 1, 2015
The Centers for Medicare & Medicaid Services (CMS) have shared the revised survey tools used
DECEMBER 11, 2015
The Centers for Medicare & Medicaid Services (CMS) has released its final PPS Rule for 2017 a
 Citing “stakeholder concerns,” the Centers for Medicare & Medicaid Services
JUNE 19, 2018
Best care practices and approaches Analyzing and using QM dat
JANUARY 25, 2019
Surveyors will scrutinize dementia care and Minimum Data Set coding in an upcoming pilot p
APRIL 25, 2014
On July 13, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a propo
Physician evaluation and management (E/M) payments cost Medicare $32.3 billion in 2010—abou
Medicare Boot Camp®—Utilization Review Version  
The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health
Analysis of recently released Medicare data has gleaned some interesting findings—a signif
Today, more and more emergency departments (ED) are using designated case managers to improve car
The Centers for Medicare & Medicaid Services (CMS), under CR 8441, states the following:
Although it plays an important role in care planning, delivery, and coordination, the care plan f
If you haven’t seen the OIG report “Medicare Compliance Review of University of Cinc
Auditing Evaluation and Management Services, Second Edition, will help
Changes in Medicare and Medicaid reimbursements, healthcare reform, and market competition are al
OCTOBER 24, 2011
Last week, CMS proposed a new rule intended to boost the success of Accountable Care Organiz
The top five reasons to attend the 2014 Medicare Compliance Forum The 2
On July 8, 2015, the Centers for Medicare & Medicaid Services (CMS) update included pr
On October 6, 2015, the Centers for Medicare & Medicaid Services (CMS) and Office of t
OCTOBER 9, 2015
On October 29, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed to revise
OCTOBER 30, 2015
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule this week that would
APRIL 21, 2016
The National Association for Home Care & Hospice (NAHC) has released a press release making t
On November 16, CMS released a final rule that bundles acute care payments for knee and hip repla
DECEMBER 8, 2015
The release earlier this month of secret Medicare Advantage audits CMS conducted on several major
Physician Practice Perspectives is filled with Medicare news, coding an
After CMS review, The Joint Commission has finally prepublished revisions to the Emergency Manage
The government should adjust Medicare payment policies to better support the type of
Centers for Medicare & Medicaid Services (CMS) Acting Principal Deputy Administrator P
Today, October 1, 2015, the U.S. health care system moves to the International Classificat
OCTOBER 2, 2015
The Centers for Medicare & Medicaid Services (CMS) has begun a three-year pilot project to i
JANUARY 8, 2016
The Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans
FEBRUARY 19, 2016
“Often we don’t pay physicians for the best care they can give.”
APRIL 28, 2016
SEPTEMBER 3, 2014
JUSTCODING
The way forward for high-quality and affordable patient care might come from the past.
JUNE 16, 2016
On August 9, CMS posted a fact sheet regarding home-based primary care. Home-based primary care a
The federal government may reimburse physicians for talking to Medicare patients and their famil
Research has shown that restrictive diets add little benefit for older adults in long-term care,
AUGUST 29, 2014
Are you caring for an aged, seriously ill or disabled family member? If so, you’re one of
NOVEMBER 20, 2015
An increased focus on value-based care is creating new jobs within hospitals, according to a repo
FEBRUARY 17, 2015
When many people think of palliative care they think of care designed to increase comfort at th
FEBRUARY 3, 2015
While I have little doubt that we will yet again revisit the management of ligature risks and beh
MAY 16, 2019
Residents can now enjoy a more home-like environment as part of their long-term care experience w
FEBRUARY 24, 2017
Q: We are doing some training on the 28/35 rule for Medicare. We know that (if it is medically ne
CMS released an interim final rule on March 31 in an effort to ease restrictions for health care
 Earlier this month, the Medicare Payment Advisory Commission (MedPAC) released the
Hospice service usage tends to be more intensive at the beginning and end of care episodes, accor
Hospice service usage tends to be more intensive at the beginning and end of care episodes, accor
CMS to hold call on value-based purchasing The Centers for Medicare &
Due to popular demand, we’ve added another Medicare Boot Camp®
Due to popular demand, we’ve added another Medicare Boot Camp®—Utiliz
Due to popular demand, we’ve added another Medicare Boot Camp®—Utiliz
Medicare Boot Camp®—Utilization Review Version
Due to popular demand, we’ve added another Medicare Boot Camp®—Utiliz
Due to popular demand, we’ve added another Medicare Boot Camp®—Utiliz
Due to popular demand, we’ve added another Medicare Boot Camp®—Utiliz
Due to popular demand, we’ve added another Medicare Boot Camp®—Utiliz
To keep themselves as closely aligned with CMS as possible, HFAP has updated their Acute Care Man
AUGUST 1, 2018
  CMS invites Medicare Part A providers to learn new Medicare Cost Report e-filing system
OCTOBER 5, 2018
Pain management Pain management
The Pioneer Accountable Care Organization model is paying off in savings, according to the Center
The Centers for Medicare & Medicaid Services (CMS) has announced that the pre-claim review de
The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI)
  Medicare Review: Ways to evaluate claims
OCTOBER 2, 2015
  Product Spotlight: Medicare Compliance Watch
SEPTEMBER 22, 2015
  Medicare's open enrollment period
NOVEMBER 18, 2016
  Avoiding Medicare fraudulent billing
JANUARY 27, 2017
  New Medicare cards are out
SEPTEMBER 22, 2017
  New Medicare Card Rollout
  Medicare to pay more for DME services
  Documentation terminology that will not support the Medicare claim
  New Medicare card mailing update
  Medicare is the secondary payer: Now what?
  New Medicare card update
SEPTEMBER 21, 2018
HHS says the new payment system for Medicare clinicians provides flexible options that encourage
On June 2, CMS issued Medicare/Provider-Enrollment-and-Certification
AUGUST 1, 2017
CMS releases advanced care planning fact sheet The Centers for M
Citing “stakeholder concerns,” the Centers for Medicare & Medicaid Services (CMS)
SEPTEMBER 1, 2018
Among the proposed changes included in the Medicare Physician Fee Schedule (PFS) for calendar ye
  October CY 2015 quarterly update to the Medicare physician fee schedule datab
The 2014 Medicare Compliance Forum (October 23–24) is the only seminar that will tea
The 2014 Medicare Compliance Forum (October 23–24) is the only seminar that will tea
CMS pilots focused surveys to assess dementia care, MDS accuracy
SEPTEMBER 1, 2014
Becoming a manager for the first time can be an overwhelming experience. You will need a whole ne
NOVEMBER 11, 2019
To keep themselves as closely aligned with CMS as possible, HFAP has updated their Acute Care
SEPTEMBER 1, 2018
Q: As part of an integrated access management program, what medical documen
A patient’s plan of care is like a road map. It provides instructions and directions on ite
The Medicare Conditions of Participation (CoPs) for home health agencies that became effective Ja
About Us
SEPTEMBER 4, 2008
On February 1, 2018, CMS proposed new Medicare Advantage and Part D payment and policy updates to
How do top healthcare providers keep nurses feeling empowered and providing optimal care for pat
JUNE 30, 2016
Clarifications made to the Medicare Benefit Policy Manual and Medicare Progra
Case managers can play a role in helping to reduce unnecessary testing.  
Medicare Boot Camp®—Utilization Review Version
CMS is expanding the information available on its medicare.gov/physiciancomp
DECEMBER 15, 2015
Electronic health records (EHR) have slowly made their way into long-term care (LTC), with
DECEMBER 23, 2016
by Josh Poltilove Restructure clinical managers’ positions so they function
The controversy around Medicare's Recovery Audit Contractor program continues; a judge has ruled
SEPTEMBER 4, 2014
  In an effort to reduce the backlog of Medicare clai
SEPTEMBER 4, 2014
Certain Accountable Care Organizations would be able to send Medicare beneficiaries to a s
OCTOBER 3, 2014
The CMS last week rolled out a new star rating system on medicare.gov/hospita
APRIL 21, 2015
The Centers for Medicare & Medicare Services (CMS) will begin beta testing on the standardize
Experts say that revamping insufficient care practices will become increasingly urg
SEPTEMBER 1, 2014
Is it possible for a patient receiving home health care to also receive outpatient pulmon
A home health agency depends on its entire care team—aides, nurses, therapists, and social
Clinical laboratory fee schedule–Medicare travel allowance fees for collection of
Inpatient hospital claims and Medicare Secondary Payer (MSP) claims with Medicare Coins
by Josh Poltilove Use CMS’ new GG self-care and mobility activity decision
A recent (March 10) study published in the American Journal of Managed Care reports that the use
The Medicare appeals process has become a logjam The Medicar
AUGUST 1, 2014
When a patient joins a Medicare Advantage (MA) plan, he or she takes on a subscriber number, but
A bill that would establish around-the-clock registered nurse staffing hours at Medicare and Me
AUGUST 7, 2014
What makes a great nurse manager? What steps do they take to drive success and engagement
DECEMBER 31, 2015
The Quality of Patient Care Star Rating methodology includes nine of the 24 currently reported pr
CMS finalizes emergency preparedness of Medicare/Medicaid-certified facilities
Agencies that select medication management as their Performance Improvement Project, or PIP, shou
CMS revises Medicare systems to accurately process inpatient hospital claims, MSP claims
A new study finds that patients diagnosed with depression often rely on their primary care physic
The Centers for Medicare & Medicaid Services (CMS) has issued guidance effective immediately
JUNE 10, 2014
In the wake of the scandal earlier this year over delayed access to care, the Department o
NOVEMBER 6, 2014
According to a CMS report of 2014 results for the Pioneer ACO Program and the Medicare Shared Sav
DECEMBER 29, 2015
Although HIM professionals do not treat or diagnose patients, their role in managing all the movi
This article has been excerpted from MDS Care Plans: A Person-Centered, Interdisciplinary App
APRIL 11, 2019
Keeping tabs on your department’s performance should be a high priority for case managers.
A new Office of the Inspector General (OIG) study has recommended to the Centers of Medicar
NOVEMBER 22, 2013
The Centers for Medicare & Medicaid Services (CMS) released a memorandum on October 21, 2016,
Medicare Boot Camp®—Utilization Review Version
 A new study suggests that care provided by nurse practitioners (NP) and physician assistant
Nurses working in acute-care settings are all too familiar with alarm fatigue, which occurs when
JUNE 7, 2018
The Centers for Medicare & Medicaid Services released an updated version of the Minimum Data
SEPTEMBER 19, 2014
The American Health Care Association (AHCA) announced its support for the sustainable grow
MARCH 27, 2015
Total health care spending growth is expected to average 5.8 percent in aggregate over 201
AUGUST 7, 2015
Centers for Medicare & Medicaid Services (CMS) will host a Special Open Door Forum on
OCTOBER 9, 2015
On August 10, 2016, the Centers for Medicare & Medicaid Services (CMS) updated the popular N
AUGUST 12, 2016
Both houses of Congress now have passed a bill that ties skilled nursing facility Medicare reimbu
In October, Medicare released its third round of penalties to hospitals that readmit patients wit
APRIL 7, 2015
On February 1, a U.S. District Court judge in Vermont ordered the Centers for Medicare & Medi
With CMS regulations making inpatient admission orders an express condition of Medicare payment,
MARCH 3, 2017
The Medicare Payment Advisory Commission (MedPAC) is once again recommending a 5% Medicare paymen
One of our nurses asked us what her legal risks are if something goes wrong when caring f
Pain Management. Please click on the PDF icon. Pain Management
  Hospitals are making progress in equitable care, according to results of a
JUNE 19, 2014
CMS finalized changes to multiple quality measures in the Medicare
  “Under the Inpatient Prospective Payment system (IPPS), Medicare reimburse
July update to the calendar year (CY) 2014 Medicare Physician Fee Schedule Database
ICD-10-related updates made to the Medicare Claims Processing Manual
http://www.medicarecompliancewatch.com/news-analysis/week-medicare-updates-9302015 
After missing a proposed fall start date, CMS has announced last week that its Medicare Part B dr
DECEMBER 27, 2016
We have a situation concerning an initial start of care (SOC) on a Medicare patient. The
Looking for ways to inspire your case managers and encourage them to meet goals? Give them a reas
DECEMBER 8, 2015
 Contingency plans help manage the aftermath of disasters that impact facility opera
DECEMBER 15, 2016
Update to Medicare Claims Processing Manualto provide language-only changes for updatin
Q: Our charge description master (CDM) manager wants to remove the code for denileukin
Medicare and other payers hold physicians responsible for correct billing and medical documentati
by Megan Herr Agencies should consider implementing a solid wound care program o
The measure is derived from the percentage of home health episodes of care during which the SOC/R
Case managers may want to keep new and troublesome trend on their radar.
  Note from the Instructor: Overview of the four parts of Medicare, Part I
SEPTEMBER 22, 2015
  Medicare Compliance Forum-Take advantage of throwback pricing!
SEPTEMBER 29, 2015
  Ending Medicare Part A Skilled Services
NOVEMBER 20, 2015
  How does a payment ban impact Medicare SNF coverage?
JANUARY 15, 2016
  More oversight is required to prevent fraud and abuse of Medicare
  Fine-tune the fundamentals: Medicare eligibility for SNF services
MARCH 24, 2016
  Medicare Part A admissions: Best practices for your facility
APRIL 22, 2016
  Proposed fiscal year 2017 payment and policy changes for Medicare announced
APRIL 22, 2016
  Medicare billing: A common compliance risk area
APRIL 15, 2016
  GAO finds Medicare appeals backlog not decreasing fast enough
  Medicare makes enhancements to the Shared Savings Program
  Centers for Medicare & Medicaid Services Special Open Door Forum
SEPTEMBER 2, 2016
  Medicare Advantage premiums remain stable in 2017
SEPTEMBER 23, 2016
  Medicare Advantage Value-Based Insurance Design Model refined
OCTOBER 7, 2016
  CMS Finalizes the New Medicare Quality Payment Program
OCTOBER 28, 2016
  CMS is updating the Medicare drug spending dashboard
DECEMBER 29, 2016
  New Medicare Compliance and Ethics Program Requirements
  Avoid common errors that lead to Medicare denials
  How to make the most of your Medicare Review
AUGUST 8, 2017
  New Medicare Card Project Special Open Door Forum
JANUARY 19, 2018
  CMS proposes Medicare Advantage and Part D payment and policy updates
FEBRUARY 2, 2018
  Updated 2018 Medicare Part B physician fee schedule in effect
MARCH 16, 2018
  Five essential resources for navigating the Medicare appeals process
MARCH 16, 2018
  Billers instructed to review CMS updates to Medicare policy manuals
MARCH 23, 2018
  Look out for new Medicare cards in the mail
  CMS raises Medicare Advantage pay rates by 3.4% for 2019
  Scrutinizing Medicare coverage for physical, occupational and speech therapy
APRIL 13, 2018
  Q&A: Post-Medicare audit processes
  Medicare's prior authorization program may continue under GAO recommendation
  New Medicare cards: What's that square code?
  CMS seeks public comment on new proposed Medicare application process
  Claims for Medicare Diabetes Prevention Program services being denied
  Flowcharts to help you with the Medicare appeals process
  Medicare physician fee schedule: What's changing for 2019?
  CMS to present an overview of the Medicare Secondary Payer Recovery Portal
AUGUST 3, 2018
  Key documentation criteria for supporting the Medicare claim
SEPTEMBER 21, 2018
  CMS releases 2019 Medicare Parts A&B premiums and deductibles
OCTOBER 19, 2018
  Your Medicare Advantage plan may be inappropriately denying payments
OCTOBER 5, 2018
  Frequently asked questions about Medicare Part B
NOVEMBER 30, 2018
How do we go about an admission that was visited only by a nurse during start of care the
To wrap up Nurses’ Week, we want to know what you think about Strategies for Nurse Manage
MAY 12, 2016
We have exciting news for our Medicare Insider customers. Starting next week, we’ll be offe
SEPTEMBER 15, 2015
Q: Is there a mandated plan from CMS to complete PPS assessments on managed ca
The Centers for Medicare & Medicaid Services (CMS) announced on a January 19 call that they a
On March 20, CMS released Medicare-Learning-N
Providers won’t have to worry about participating in a new set of mandatory Medicare episod
A new June 2017 Medicare Payment Advisory Commission (MedPac) report suggests implementing a unif
The healthcare industry by definition exists to care for the health of each individual. But how w
FEBRUARY 13, 2015
Update to Medicare Claims Processing Manual, Chapters 12, 20, 32, and 35 to prov
Self-care data suggests that patient engagement and motivation are critical ingredients for effec
A home health agency depends on its entire care team—aides, nurses, therapists, and
A home health agency depends on its entire care team—aides, nurses, therapists, an
A home health agency depends on its entire care team—aides, nurses, therapists,
A home health agency depends on its entire care team—aides, nurses, therapists,
A home health agency depends on its entire care team—aides, nurses, therapists
A home health agency depends on its entire care team—aides, nurses, therapists, and social
The Helping Hospitals Improve Patient Care Act was introduce
Medicare Boot Camp—Utilization Review Version is an i
Q: We have started receiving an edit for our pain management procedures reported with C
By Velvet Thorne, LPN, CLNC, Population Management Trainer, HealthEC As p
FEBRUARY 19, 2020
According to the National Hospice and Palliative Care Organization, hospice organizations should
According to the National Hospice and Palliative Care Organization, hospice organizations should
Q: We have a patient that meets Medicare eligibility for home health services, remains ho
DECEMBER 16, 2015
JUSTCODING
With healthcare complexity increasing daily, traditional models of delivering care fail to offer
DECEMBER 29, 2016
  Pain management
JANUARY 1, 2014
  Time management
SEPTEMBER 1, 2013
  Proactive Denial Management
DECEMBER 14, 2016
CMS posts July update to Medicare Physician Fee Schedule Database On June 6, CMS rel
A healthcare payment reform advocate is calling on Medicare officials to shift away from agency's
Last Thursday, President Barack Obama signed into law a bill to permanently repeal Medicar
Medicare accountable care organizations (ACO) saved the federal government more than $411 million
by J’non Griffin Home care providers should weigh options for providing mo
Moving on to the rest of the guidance document (it still Medicare/Pr
FEBRUARY 28, 2019
Modifying the Daily Common Working File (CWF) to Medicare Beneficiary Database (MBD) Fi
MLN Matters released the January 2015 edition of the Medicare Quarterly Provider Complia
medicare-updates-%E2%80%93-100
The National Association for Home Care and Hospice (NAHC) released a d
The Medicare Fraud Strike Force swept through 10 states and arrested 243 people—46 of the
As Medicare and Medicaid celebrate their 50th anniversary protecting the health and well-b
AUGUST 7, 2015
CMS recently expanded the amount of data available on its medicare.gov/
Although CMS has issued blanket waivers, the vast majority of the Medicare requirements remain in
OIG finds $268M in Medicare hospice overpayments Recent investigations by
The 2015 Medicare Compliance Forum pairs leading Medicare experts with practicing provider
The government shutdown began at midnight Jan. 20. But HHS’ website indicates the Medicare
Coders may report critical care provided in the ED. Critical care is defined as the direct delive
In the course of patient care, every patient/family interaction is an opportunity to educate, say
JUNE 15, 2017
By Julie Mills, RN, MBA, senior manager, clinical solutions executive, PerfectServe
JANUARY 28, 2020
HCPro, Inc., has expanded into managed care publishing by acquiring National Health Information,
AUGUST 31, 2006
On November 16, 2015, the Centers for Medicare & Medicaid Services (CMS) issued the final rul
The National Partnership to Improve Dementia Care in Nursing Homes is a partnership between the C
Some of the requirements for home care include: If the patient does in fact leave the hom
If you think the tension between managers and medical staff is something unique to healthcare in
Clinical documentation improvement (CDI) specialists and case managers share a common goal but of
One might argue that the most effective managers are those who don't manage alone. Effective mana
AUGUST 18, 2016
CMS began publishing home health agency (HHA) Quality of Care star ratings, based on OASIS data a
When Congress passed the Protecting Access to Medicare Act of 2014, it mandated at least a
MAY 7, 2014
JUSTCODING
 Be prepared for renewed interest in your water management program and especially how it is
SEPTEMBER 1, 2018
by: Tami Swartz   A short but intense stay on the routine home care level of
Q: Some of my staff seem unclear about the parameters of the resumption-of-care
On November 4, 2015, The Centers for Medicare & Medicaid Services (CMS) announced that it has
NOVEMBER 6, 2015
Risk adjustment is central to pay for performance, whereby high-quality cost effective care can b
OCTOBER 28, 2015
JUSTCODING
All Medicare-approved hospice providers must submit an annual cost report to the MAC. The cost re
A June 23 news release by the National Association for Home Care & Hospice (NAHC) states the
  Bowel and bladder management Bowel and bladder management
FEBRUARY 1, 2014
Since its initial inception as part of Section 6106 of the Affordable Care Act, the payroll-based
SEPTEMBER 1, 2017