Expect more changes to come for provider-based clinics. There has been much federal oversight activity regarding provider-based clinics of late. For those of you that have such clinics and/or are anticipating the development of such clinics, study the rules, regulations, and pronouncements of the Centers for Medicare & Medicaid Services…
E&M changes, opioid crisis among issues profiled in the following forecast As the commentators who predicted that the Segway would revolutionize travel well know (you can read about that in Time), making predictions about how the world will change is challenging. When I storm-chase, I think of myself as a…
CMS to launch new Patient-Driven Payment Model October 2019. The Centers for Medicare & Medicaid Services (CMS) was tired of paying too much for care in nursing homes. They were tired of fighting with lawyers and consultants driving up payments and gaming the system.  CMS is finally replacing the Resource…
Errors persist in another communication on a key knee procedure. Sixteen days after the original MLN Matters publication titled “Total Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight Rule” was released, it was reissued today with clarifications. If you’re not aware why it…
CMS audit performance gauged in HHS OIG announcement.  If the Centers for Medicare & Medicaid Services (CMS) received a grade for its audit performance during the 2015 and 2016 fiscal years, it would have been about a B-plus, maybe waived up to an A-minus, according to an announcement made this…
CMS E&M FAQ is likely to generate more questions than answers. Since the release by the Centers for Medicare & Medicaid Services (CMS) of the 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, many of us have been scurrying around trying to make sense of two evaluation and management (E&M)…
Lawsuits initiated by whistleblowers under the False Claims Act. Last Wednesday, in a petition to the United States Supreme Court, Intermountain Healthcare (Intermountain), the largest healthcare provider in the Intermountain U.S., made headline legal news by challenging the constitutionality of the False Claims Act (FCA), one of the government’s most…
Expect more mass production of audits. Looking forward to the remainder of 2019, we will see a number of exciting information technologies (IT) that will reshape healthcare and Medicare. These include artificial intelligence (AI), the cloud, DNA sequencing, in silico testing of new molecular entities (NMEs), and distributed ledger systems,…
Latest move by CMS raises more questions. CGS, a Medicare Administrative Contractor (MAC), on Thursday released an email notice indicating that the Centers for Medicare & Medicaid Services (CMS) has instructed it to stop seeking recoupment or issuing demand letters for Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) Hospital…
This is day 27 of the partial government shutdown. The ongoing government shutdown will likely affect Social Security Disability (SSDI) recipients who are applying for Medicare. By law, SSDI recipients must wait two years from the date of their receipt of disability benefits to qualify for Medicare. Delays in decisions…