Discharge Planning Conditions of Participation guidance from CMS is being seen as unhelpful. As hospitals prepare to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of…
CMS and the Department of Veterans Affairs (VA) recently announced a new data sharing initiative in which the departments will share provider enrollment data to prevent healthcare fraud, waste, and…
The owner of a transportation company has pleaded guilty to fraudulently billing millions in false claims to the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today. Michael Davini,…
CMS clearly is honing-in on reducing administrative burden as changes go into effect. On Friday, Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee…
There are 2,115 additions to the third quarter Medicare National Correct Coding Initiative (NCCI or CCI) practitioner edits that became effective July 1, 2019. The good news is that the…
A new HCPCS Level II code lets you report the SinuvaTM implant for nasal polyps, but coding for placement may vary based on the encounter. Medicare Administrative Contractor (MAC) National…
Agencies continue their investigation into the underlying cause of electronic cigarette/vaping-associated lung injury. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to…
Becker's Hospital Review reported on the following payment model updates from CMS or HHS in October: 1. CMS is now taking applications for kidney care payment models. Participation in the…
Too little attention is paid to documentation, coding, and billing in many medical practices. For patients, documentation simply means that your doctor is providing an account of your visit in…
Providers should keep in mind that such policies aren’t binding – but can offer valuable direction. Imagine your Medicare Administrative Contractor (MAC) had a policy detailing their coverage of records…
Securing successful contracts with payers is becoming increasingly important for ASCs as they move toward negotiating value-based contracts. Lisa Davis, administrator at The Center for Minimally Invasive Spine in Munster,…
Most healthcare organizations partner with physician services groups for niche coverage. While outsourced medical services are available across all specialties, common areas for external physician support include anesthesia, radiology, wound…
Health plans and other stakeholders are convinced that the use of ICD-10 coding can greatly launch the uniform capture of data related to social determinants of health and improve health…
More than 700 pages of text make up proposed changes to the federal Stark and anti-kickback statutes. On Wednesday, Oct. 9, federal healthcare officials announced two new proposed rules. While…
I shouldn’t be surprised. I have been reviewing denials by insurance companies since the late 1980s. I’ve seen the same things over and over again, such as slow pay, delayed…
Medical coders are typically behind the scenes of patient care, analyzing records, selecting codes for billing, and managing patient data. But to Jannifer Owens, a revenue cycle expert with over…