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Will CMS address the “absurdity” embedded in the rules of outpatient coding? Every once in a while, something comes to my attention that I choose not to discuss in public. Over a year ago, I was asked about physician billing for observation services. When a patient is hospitalized, the physician…
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Two efforts are underway to prevent HHS from cutting Medicare payments to hospitals participating in the 340B drug program. The 340B drug program is under assault, with the latest action coming the from the American Hospital Association (AHA) – which, along with  the Association of American Medical Colleges (AAMC) and…
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As use of EHRs increases, so too does the potential for fraud. The use of electronic health records (EHRs) is expanding at a rapid pace, and so is the opportunity for fraud involving these systems. An EHR is a digital version, or database, of a patient’s paper charts. The systems…
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As it pertains to an important issue first raised in October 2016, CMS last week made a key change, effective Jan. 1, 2018. In a surprise move last week, the Centers for Medicare & Medicaid Services (CMS) agreed to pay for outpatient dialysis for patients with acute kidney failure (AKI)…
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CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months. The town’s mayor has asked for help from Washington. There are towns in America where time seems to stand still. And that might be the case in the small, rural town…
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A low volume appeals settlement and an expanded Settlement Conference Facilitation process are two initiatives to improve the Medicare claims appeal process. On Friday, the Centers for Medicare & Medicaid Services (CMS) and the Office of Medicare Hearings and Appeals (OMHA) announced two new settlement options for Medicare providers and…
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CMS sets up virtual participation for rural healthcare providers in the government’s MIPS program. New announcements from the Centers for Medicare & Medicaid Services (CMS) are important for providers to take note of moving forward. Of particular note are the following rules that CMS has withdrawn. These include the following:…
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CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months. The town’s mayor asks for help from Washington. Jill Holland, the mayor of the rural town of McKenzie, Tenn., population 5,300, is seeking the help of U.S. Sen. Lamar Alexander (R-Tenn.)…
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CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months. As they would react to a flood, ice storm, or fire, local officials and residents in the rural town of McKenzie, Tenn. are rolling up their sleeves and taking on a…
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Report offers peek behind the curtain at financial picture. The Centers for Medicare & Medicaid Services (CMS) just released a preliminary report outlining the first-year results of the Comprehensive Care for Joint Replacement (CJR) program. The report on the first mandatory “bundled payment” program reveals that participating hospitals were able…