Read more about the article Medicare Skilled Nursing Facility Billing Changes for 2020
Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update

Medicare Skilled Nursing Facility Billing Changes for 2020

Effective January 1, 2020, with an implementation date of January 6, 2020, the Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing…

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Read more about the article Medicare Local Coverage Determinations Create Inconsistency in Medicare Coverage
Medicare administrative contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) sometimes develop policies to limit Medicare coverage of specific items and services. MACs issue local coverage determinations (LCDs) that limit coverage for a particular item or service in their jurisdictions only. This can lead to State-by-State variation in Medicare coverage for similar items and services.

Medicare Local Coverage Determinations Create Inconsistency in Medicare Coverage

Medicare Local Coverage Determinations (LCDs) are inconsistent and cause uneven access to care for Medicare beneficiaries based on arbitrarily geographic boundaries and jurisdictions, rather than on medical necessity. That is…

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Read more about the article OIG Regulatory Guidance Standards
OIG Regulatory Guidance from the Office of the Inspector General for U.S. Department of Health and Human Services

OIG Regulatory Guidance Standards

What is OIG Regulatory Guidance in Healthcare? OIG Regulatory Guidance has seven elements and is divided by the healthcare industry sector. The U.S. HHS Office of the Inspector General (OIG)…

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Read more about the article Medicare Changes to Skilled Nursing PDPM in 2020
Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update

Medicare Changes to Skilled Nursing PDPM in 2020

As of 2020, CMS has mandated that Skilled Nursing Facilities (SNFs) adopt the new Patient-Driven Payment Model (PDPM), certification surveys.  Additionally, SNFs must use the QAPI process.  QAPI is the…

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Read more about the article Pharmacy Benefit Manager Expert Witness
Pharmacy Benefit Managers - U.S. Pharmacy Distribution and Reimbursement System

Pharmacy Benefit Manager Expert Witness

Pharmacy Benefit Manager Expert Witness A Pharmacy Benefit Managers expert witness (also known as PBM expert witness) must comprehend that Drug Prices are complex. First, I'm introducing some introductory concepts.…

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