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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Medicare Part D Expert Witness
Medicare Part D and Medicare Part C Appeals Process is Essential Expert Witness Specialized Knowledge

Medicare Part D Expert Witness

A Medicare Part D Expert Witness should understand the differences between how Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part C are administered. Finding a Medicare…

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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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Dual Eligibles for Medicare, Medicaid come under fire

  Dual Eligibles for Medicare, Medicaid cost too much.   The administration that created the Patient Protection and Affordable Care Act with Medicaid expansion as a centerpiece to cover more low-income insureds…

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ICD-10 – Let’s Get On With It

We do not support a delay in ICD-10. The delay hurts not only those who have invested dutifully to meet the CMS mandate on time, but it hurts independent contractors, small businesses, and Healthcare IT vendors who fill knowledge gap in Covered Entities who don't have the staff internally to meet this mandate.

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ICD-10 Readiness Compromised by ICD-10 Revenue Cycle, Analytics Vendors

We find that most analytics and revenue cycle companies are ignoring the future role coordinated medical coding will have, the transition to ICD-10, and the clinical documentation and processes on the revenue cycle. The ICD-10 transition will re-write the book on revenue cycle management (RCM). RAC audits and Electronic Medical Records (EMRs) will be subject to a new paradigm with ICD-10.

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9/28/09 – Weekly Health Care Reform Update at the Federal and State Level

Week of September 28, 2009 The Senate Finance Committee wasted no time last week in wading through a seemingly endless number of amendments to its proposed health care reform legislation…

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