Tag Archives | Medicare

CMS Cancels Two Mandatory Pay Models and Scales Back a Third

The CMS on Tuesday said it will toss two bundled-payment models and cut down the number of providers required to participate in a third, citing providers’ requests to have more input in the models’ designs. The agency slashed the number of mandatory geographic areas participating in the Comprehensive Care for Joint Replacement, or CJR, model […]

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CMS Tackles Opioid Prescribing

The Centers for Medicare & Medicaid Services (CMS) intends to align its Medicare plans, including Part D prescription plans, with the Centers for Disease Control and Prevention (CDC) opioid prescribing guidelines. On January 5, 2017, the agency released a statement justifying this action. Because of  “the growing body of evidence on the risks of misuse […]

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CMS Exempts Two Thirds of Clinicians From MIPS

The Centers for Medicare & Medicaid Services (CMS) has exempted about two thirds of physicians and other clinicians who provide care to Medicare beneficiaries from the Merit-based Incentive Payment System (MIPS), a pay-for-performance scheme that will determine part of physicians’ Medicare payments, starting in 2019. A CMS spokesman told Medscape Medical News, “CMS mailed approximately […]

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Feds Crack Down on Upcoding

By the time the late President Lyndon B. Johnson signed the law establishing Medicare and Medicaid in 1965, the health care community was already figuring out how to maximize its returns from these new programs designed to insure the elderly, poor, and disabled. Those proceeds, however, have been generated over the years in ways that […]

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Why Medical Necessity Continues to Be a Top Priority

Medical necessity is an important issue. Just review the definition of medical necessity: “a legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.” So, what does that really mean? A few years ago, I was preparing to speak at a national conference with […]

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Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant

The goal was to avert fraud, waste, and abuse. We all support that – we collectively pay for Medicare, and who likes throwing their money away? Let’s review the ideal: the patient receives excellent medical care, the provider does a good job documenting that care, the coder translates the documentation into codes that are submitted […]

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Don’t Write Off Patient Co-pays

It comes naturally to want to help your patients; especially the ones struggling to get by on a meager income or retirement.

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HIMSS Launches Interactive ICD-10 Transition Guide

HIMSS has launched the ICD-10 Transition Step-by-Step Guide, an interactive tool aimed at assisting healthcare providers who have not completed the transition to the ICD-10 code set for submitting claims to the Centers for Medicare and Medicaid Services (CMS) and other payers.

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An Early Warning System for Reducing ICD-10 Claim Denials

In the recent ICD10 monitor article ICD-10 is Risky Business, Holly Louie states that “the best way to fix claim errors is to not make them in the first place.” Since the Oct. 1 implementation of ICD-10 has passed, how will your organization know when and where errors are likely to occur so you can […]

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Four States Get ICD-10 Deadline Extension

Four state Medicaid programs have been approved by the Centers for Medicare & Medicaid Services to delay transitioning to ICD-10 codes by the Oct. 1 deadline.

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AMA’s Long War of Words Against ICD-10

One of the more notable things about the Centers for Medicare & Medicaid Services’ revisions to its ICD-10 policy on Monday is the fact that the suggestions come straight from the AMA. After all, there’s been no love lost between the two organizations when it comes to that subject these past few years.

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CMS Will Reimburse ICD-10 Mistakes

The CMS has made a concession in the transition from ICD-9 to ICD-10.

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CMS Offers ICD-10 Advice for the Home Stretch

The Centers for Medicare and Medicaid Services has just released a fact sheet on preparing for ICD-10. This latest message offers suggestions for providers whose information systems may not be ready in time for the Oct. 1 transition deadline. The facts sheet also attempts to dispel some myths and issues a warning.

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RAC Court Ruling Deals Blow to CMS

A US Court of Appeals ruling earlier this month that invalidates a provision of Medicare’s 2014 Recovery Audit Program contracts is the latest setback for federal officials who administer the program.

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SGR Replacement Bill Has Big Implications for Health IT

On Thursday, Senate and House lawmakers introduced bipartisan, bicameral legislation (HR 1470) to permanently replace Medicare’s sustainable growth rate formula that includes several health IT provisions, Modern Healthcare reports (Tahir, Modern Healthcare, 3/19).

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Medicare Hospital Compliance Reviews are Legal and Sound, According to OIG

The Office of Inspector General for the Department of Health and Human Services (OIG) recently defended its practices pertaining to hospital compliance reviews in a published response to a letter from the American Hospital Association (AHA), while simultaneously announcing a voluntary suspension of reviews of inpatient short stay claims after October 1, 2013.

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