The new rule contains two key requirements—annual disclosure of prices and 300 “shoppable” items. Effective Jan. 1, 2019, the Centers for Medicare & Medicaid Services (CMS) required that hospitals publish…
More changes are likely coming. As many of you have heard, there are major changes coming to evaluation and management (E&M) codes in 2021. The changes were finalized in the…
CMS report is based on 2016-2017 data. It’s been two years since the American Hospital Association (AHA) shouted from the rooftops that documentation by any interprofessional team would be accepted…
Among the proposed new rules is one intended to clarify the contentious “Stark Law.” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to…
WHY WE DID THIS STUDY We undertook this study because of concerns that Medicare Advantage organizations (MAOs) may use chart reviews to increase risk adjusted payments inappropriately. Unsupported risk adjusted…
EDITOR’S NOTE: CORRECTION: In the RACmonitor Nov 29, 2019 edition, Dr. Ronald Hirsch noted that resource use data on skilled nursing facilities (SNFs) was not available on the SNF Compare…
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…
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…
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…
A “bold proposal” to reduce the documentation burden on physicians was released as part of CMS’s 2019 proposed Medicare Physician Fee Schedule (PFS). This seemed to have begun as an…
A change in government payment policy for dermatologists and other physicians in selecting office coding and billing for evaluation and management (E/M) is scheduled to begin January 2021. “The Centers…
Hospitals support the CMS' proposed changes to medical billing coding and new payments for opioid treatment programs, but they're worried that changes to quality measures could hurt providers. Major medical…
The announcement is all but ensured to trouble providers already concerned about overreach. Federal healthcare oversight authorities have announced that they are expanding their “revocation and denial authorities” in an…
CMS has provided ICD-10 Procedure Coding System updates for the fiscal year beginning Oct. 1, 2019, and ending Sept. 30, 2020. Four takeaways: 1. The updated ICD-10-PCS codes are for…
Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2,…