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…
The Centers for Medicare & Medicaid Services (CMS) issued a final rule on September 5, 2019, intended to address program integrity and vulnerability issues. The Office of the Inspector General…
For quite a long time, Medicare and Medicaid have been included on a Government Accountability Office (GAO) rundown of government programs that are at an expanded danger of misrepresentation, waste,…
In September 2018, HHS Office of Inspector General (“OIG”) issued audit Report No. A-01-15-00500 (the “Report”) finding that out of 220 randomly sampled inpatient rehabilitation facility (“IRF”) stays from 2013,…
Whether you are dealing with a commercial payer, Medicare, or Medicaid, there are certain types of improper claims that should be avoided if you want to reduce your risk of…
On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would redesign the Medicare Shared Savings Program (MSSP). The proposed changes would accelerate…
Change is never-ending for ambulatory surgery centers (ASC's). ASCs need to always stay on top of the seemingly nonstop influx of contractual and coding changes, which can have a direct…
(Editor’s Note: Dr. Terri Lewis has been very critical of the CDC for not requiring data collection about chronicity or context of chronic disease. She has been discussing this issue…
New identification cards the government is sending out to all Medicare recipients in an effort to deter fraud may actually end up encouraging scammers and hindering physician billing, according to…
A new government report finds that Medicare improperly paid acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities. And now Medicare wants the…
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…
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…
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…
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…
It comes naturally to want to help your patients; especially the ones struggling to get by on a meager income or retirement. At first blush, it may make sense to…
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…