What is Promoting Interoperability? Promoting interoperability was formerly known as "Meaningful Use" under the ARRA HITECH Act of 2009. Promoting interoperability promotes patient engagement and electronic exchange of information using…
Medicare Local Coverage Determinations for Genetic Testing Medicare Technical Assessment for Molecular Assays To determine coverage for genetic test Medicare LCD, the Centers for Medicare and Medicaid (CMS) requires a…
PAID Act Plus SMART Act Requires NGHPs to Report or Pay Penalties The Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007 contains mandatory insurer reporting in Section 111 for…
CPT Test Procedure Codes for COVID-19 Testing COVID-19 testing and diagnosis codes are an essential component to collecting and analyzing data to understand the pandemic. U.S. Health and Human Services…
The Medicare Beneficiary Identifier (MBI) is now required for all Medicare transactions. In other words, for medical billing use of the MBI is essential. The Centers for Medicare & Medicaid…
Home Health Patient Driven Groupings The Centers for Medicare and Medicaid (CMS) announced a new Patient-Driven Groupings Model for Home Health that replaces the Prospective Payment System effective January 1,…
Forbes published an article on December 11, 2019, after interviewing the Administrator of the Centers for Medicare and Medicaid Services (CMS), Seema Verma. Ms. Verma itemized three focus areas: the lack…
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)…
The Centers for Medicare & Medicaid Services (CMS) has issued the federal fiscal year (FFY) 2020 final rule for the skilled nursing facility prospective payment system (SNFPPS). Highlights of the…
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…
HR 2156, the Medicare Audit Improvement Act of 2015 legislation proposes changes to the Recovery Audit Contractor (RAC) program just in time for ICD-10
ICD-10 will drive initiatives such as bundling, as a component of health care payment reform. Therefore reimbursement, and case management and other areas must be viewed in a broader landscape. HIPAA mandates and health care reform impact one another.