Special Bulletin

OIG discusses plans in 2018 Work Plan update The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced on Thursday that the agency, along with the Centers for Medicare & Medicaid Services (CMS), has noted “problems” with upcoding in hospital billing to increase payment. As…
THIS STORY HAS CORRECTED TO REFLECT THE NOV. 2 RELEASE OF THE FINAL FOR 2019 EDITOR’S NOTE: CMS on Thursday released the 2019 Medicare Physician Fee Schedule. For 2019 and 2020, we will see no changes to our outpatient, office-based evaluation and management (E&M) services, but things will change come…
Release by CMS caps months of debate by stakeholders Long awaited and hotly debated, the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) final rules have been on the minds of healthcare shareholders since late July, when the Centers for Medicare & Medicaid Services (CMS) released proposed rules…
Monday was the last day that CMS could have finalized the rule changes, per law. Three years ago this week, the hospital case management world was sent into turmoil by the release of CMS-3317-P, a 125-page Centers for Medicare & Medicaid Services (CMS) proposed rule titled “Revisions to Requirements for…
RAC issue for IRFs has moved from being proposed to being approved. The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex Medical Review for (inpatient rehabilitation facilities) IRFs. The issue: 0A024-Inpatient Rehabilitation Facility (IRF) Stays: Meeting Requirements in the proposed Recovery Audit Contractors (RAC) Topics list…
CMS says proposal will save U.S. healthcare facilities $1.12 billion annually. In a surprise move, the Centers for Medicare & Medicaid Services (CMS) has released proposed rule CMS-3346-P to, in the words of its title, “Promote Program Efficiency, Transparency, and Burden Reduction.” The proposed rule contains regulation changes applicable to…
EDITOR’S NOTE: The following article was originally published on the American College of Physician Advisors (ACPA) blog by the author. I never really understood how my “square peg” of work as a geriatrician was supposed to fit into the “round hole” of evaluation and management (E&M) CPT® coding with its…
Error reported by WPS/GHA  might have nationwide ramifications. Medicare Administrative Contractor (MAC) WPS GHA today confirmed that an enhancement to its Fiscal Intermediary Shared System (FISS) caused erroneous additional documentation request (ADR) letters to be sent to providers. In a posting to its website, WPS GHA reported that the error…