Just a day after the FDA approved the emergency use of a new COVID-19 antibody drug, CMS updated Medicare payment and billing policies to ensure providers have access to the…
Medicare contractors were inconsistent in how they reviewed overpayments during the appeals process, says the Office of Inspector General in a new report. Although MACs and QICs generally reviewed appealed…
Centers for Medicare & Medicaid Services are proposing to eliminate the inpatient-only list over the next three years. Medicare’s often-misunderstood inpatient-only list may soon be departing, as the Centers for…
Medicare outpatient payments are slated to increase by 2.6 percent next year, a $7.5 billion boost compared to 2020, according the proposed 2021 Outpatient Prospective Payment System (OPPS) rule. Released…
On July 20, the Office of Inspector General (OIG) released a report that found that hospitals are overbilling or upcoding hospitals to the tune of $1 billion. OIG reviewed 200…
The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a…
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…
CMS’s IMM sends mixed messages to providers. The Important Message from Medicare (IMM) has changed significantly in its latest reiteration, and the IMM now must be presented to both Medicare…
New Medicare office-visit coding guidelines take effect Jan. 1, 2021, and are designed to be more intuitive and make unnecessary documentation tasks go away. Experts believe the transition will be…
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,…
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…
AI presents an entirely new landscape for defense against audits. The Trump administration has launched a program to employ artificial intelligence (AI) in Medicare audits. Use of AI will make…
Noridian uses scenarios for the parenteral administration of iron in non-dialysis patients. The Noridian iron infusion Local Coverage Determination (LCD) is important for just about everyone since Noridian is the…
Q: Is reporting of Current Procedural Terminology (CPT) codes 99218-99220 restricted to a single physician? A: According to CPT guidelines, only the physician or non-physician practitioner (NPP) placing the patient…
The Centers for Medicare & Medicaid Services (CMS) recently published the 2020 Medicare Physician Fee Schedule (MPFS) Proposed Rule. While many issues are included in the 1,700-page rule, three are…
Say goodbye to RUG-IV, and hello to the Patient-Driven Payment Model (PDPM). This is a daunting task, not for the faint of heart. Under PDPM, reimbursement for Medicare Part A…