The Department of Justice (DOJ) recently filed suit against Anthem, Inc. (Anthem) alleging that the Medicare Advantage Organization (MAO) violated the False Claims Act (FCA) when it knowingly failed to delete inaccurate...more
Starting Oct. 1, per diem payments to skilled nursing facilities (SNFs) will be more generous on the first few days of a Medicare beneficiary’s stay, and then drop as the stay continues. That’s one of the changes under the...more
If you think you’re waiting even longer at your doctor’s office these days, you might be right. And it might be due to the overhaul of the medical billing code system that requires providers to enter an alphanumeric...more
CMS recently reminded providers that Medicare claims with a date of service on or after October 1, 2015, “will be rejected if they do not contain a valid ICD-10 code.” As CMS explained, “[t]he Medicare claims processing...more
All across the country hospitals have been bracing for the scheduled Oct. 1, 2015, transition from ICD-9 coding to ICD-10. It had been scheduled for Oct. 1, 2014, but the Protecting Access to Medicare Act of 2014 delayed it...more
Providers of behavioral health services should be aware that the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), released in May 2013 after more than ten years in...more
In recent months, as the conversation about reforming the health care system has shifted to achieving greater delivery system efficiencies, cost containment, and patient satisfaction, the role of health care...more
Congress begins its summer recess this week, but last week legislators were busy holding hearings on management issues regarding HealthCare.gov, introducing legislation to increase payments to primary care doctors under...more
The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more
Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more
On December 2, 2013, the Federal Register published CMS’s Final Rule regarding the prospective payment system (PPS) for End-Stage Renal Disease (ESRD). Most provisions are effective on January 1, 2014, with limited exceptions...more