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HRSA claims delay will have no impact on current stakeholders. The Health Resources and Services Administration (HRSA), which administers Section 340B of the Public Health Service Act, has published a proposal to delay for another year the ceiling price and civil monetary penalties regulation that was originally issued by the…
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Level of care is increasingly becoming a source of payer utilization review denials It was widely recognized after the Centers for Medicare & Medicaid Services (CMS) adopted meaningful use and the widespread transition to electronic medical records (EMR) that EMR transition affected billing by hospitals. For payers that have per…
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Those involved in compliance will want to keep tabs on these changes with due concern. The Bipartisan Budget Act of 2018 (BiBA) was signed into law on Feb. 9, 2018. As is typical with these budget bills, there are more than 2,000 pages, including a hodgepodge of issues involving healthcare.…
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There are now 200,000 new targets for CMS and private payers. Since the first of this year, I have engaged in several audits for which the target is not the physician, but rather a physician’s assistant (PA) or a nurse practitioner (NP). While there have always been audit issues regarding…
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I am changing my interpretation of the final rule with help from the trenches. Often referred to as the “carpenters” of medicine, orthopedic surgeons are not well-known for deep contemplation of Centers for Medicare & Medicaid Services (CMS) rules. But I’ll be damned if I haven’t had to wrestle with…
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CMS has created a giant loophole that continues to perplex. I get a lot of questions about status changes. To explain how even the seemingly simple questions are not always so easy, I want you to picture a patient. She is 75 years old and has a cough. She is…
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The promise of patients over paperwork may greatly benefit hospitals. The Centers for Medicare & Medicaid Services (CMS) has posted the 2019 Inpatient Prospective Payment (IPPS) Proposed Rule, with the agency suggesting it would strip away language that a physician’s order must be in the medical record in order for…
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June 8, 2018 is the deadline for participation. Like watching the sunset approach the horizon, time is running out for hospitals and health systems weighing their participation in new initiatives being offered by the Office of Medicare Hearings and Appeals (OMHA) to settle backlogged claims at the Administrative Law Judge…
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CMS does not specify effective date for new changes. The Centers for Medicare and Medicaid Services (CMS) has published a decision memo for Magnetic Resonance Imaging (MRI). The decision memo, posted on Tuesday by CMS, reviewed the proposed updates to the National Coverage Determination (NCD) 220.2 (C )(1) and 220.2…
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Don’t count on headlines; reading the fine print is crucial. Recently I presented a RACuniversity webcast on the changes to the National Coverage Determination (NCD) for automatic implantable cardioverter defibrillators (ICD), the MitraClip, and more. If you missed it, you can still watch it on demand. There are a couple…