Posted and filed under Compliance, Technology.

EHR Incentive Program Deadlines

The Medicare and Medicaid EHR Incentive Programs were designed to provide eligible professionals (EPs) the opportunity to receive EHR incentive payments as they adopt, implement, upgrade, or practice meaningful use of relevant EHR technologies. The EHR Incentive Programs have three stages: Stage 1 set the foundation for the EHR Incentive Programs by establishing requirements for…

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Posted and filed under Community, Healthcare.

CMS Offers Aid to Hurricane Maria Victims

Seema Verma, administrator of The Centers for Medicare & Medicaid Services announced earlier this week that the organization would be stepping up to help Puerto Rico and the U.S. Virgin Islands after Hurricane Maria’s reign of destruction. Health and Human Services has already declared public health emergencies in these affected territories, eliciting help from a…

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Posted and filed under Coding, FWA.

Investigating Health Plan Overpayments

Picture yourself balancing on top of a fence with vast expanses of land, each with their own set of governance, visible to you from both sides. You’re straddling the fence, your legs occupying each of the divided spaces. Where do you stand? It depends on which way the wind blows. Such is the case with…

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Posted and filed under Dental, Fraud, FWA.

Fraud Round-Up

If you read the news, you know that health care fraud is just as prevalent as ever. During any given time, you will be able to find a headline about a provider or care giver defrauding patients, insurance companies, or CMS in every state across the nation. This month we’ve seen quite a few colorful…

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Posted and filed under Payers.

CPC+, What’s all the Fuss?

Yesterday, CMS announced the next phase of their enterprising initiative to improve primary care. This nation-wide primary care model is the largest of its kind, and is known as the Comprehensive Primary Care Plus (CPC+), is a five-year primary care medical home model aimed to begin in January 2017. CPC+ plans on creating a culture…

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Posted and filed under Healthcare.

What Constitutes “Supervision” of Diagnostic Tests?

If you work in healthcare, it is assured you’ve heard the term supervision a lot. Non-Physician Practitioners are supervised, Physician supervised services, general supervision, direct supervision, personal supervision. In the suite, out of the suite, counter signature. These are elements of supervision, and are exactly what adds to the layers of confusion regarding supervision. Special…

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Posted and filed under FWA.

Top Recent Regulatory Activities by the US Government

Recently, the U.S. Government has been undertaking regulatory activities to drive down healthcare costs and improve patient outcomes. It is crucial to keep an eye on published regulations. One of the Centers for Medicare and Medicaid Services’ (CMS) key goals is to pay claims right the first time. This means paying the right amount to…

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Posted and filed under Healthcare.

The Two Midnight Rule 2016 Exception

CMS released CY 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule (CMS 1633 P). In which they propose to allow an exception to the controversial Two Midnight Rule. This proposed change is in recognition that there may be times when an inpatient admission (Part A payment) may be clinically warranted for stays that span less…

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Posted and filed under Coding.

CMS Proposed Rule: New Reporting Requirements for Labs

The Centers for Medicare & Medicaid Services (CMS) released, Sept. 25, a proposed rule that will significantly revise the Medicare payment system for clinical diagnostic laboratory tests (CDLTs) and advanced diagnostic laboratory tests (ADLTs) paid under the Clinical Laboratory Fee Schedule (CLFS) beginning in 2017. The new payment system will base payments on a weighted…

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Posted and filed under Coding, Compliance.

ER Upcoding Rules & Regulations To Be Aware Of

Does documentation of more than 50% of time spent counseling or coordinating care suffice for time documentation, and therefore E/M code level selection? Many will answer: YES Let’s take a peek at an often forgotten CMS rule “In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria…

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