Dealing with Quality Assurance and Performance Improvement (QAPI) compliance isn’t exactly new—but the Centers for Medicare & Medicaid Services (CMS) has recently thrown you a curveball. In an effort to help nursing facilities cultivate a proactive QAPI culture, the agency has unveiled new requirements. Here’s More..
As a HIPAA-covered entity, your medical establishment is required by the HIPAA Breach Notification Rule to provide notification following a breach of unsecured protected health information (PHI). Depending on the number of individuals your PHI breach affects, you may need to notify each affected individual, More..
For years, you’ve endured an agonizingly slow claims appeals process due to the enormous backlog of pending appeals. But now, the U.S. Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) is rapidly speeding things up. Find out what this More..
It’s not hard to violate Stark law without realizing it, which means you’re always exposed to Stark law violations. Also, there are certain situations in when Stark does not apply—making your compliance strategy even trickier to master. Good news: Recent Stark law amendments and case More..
Your hospital’s claims for telemedicine services are coming under fire, and you could soon see a significant crackdown on your compliance efforts. Get ready for the Centers for Medicare & Medicaid Services (CMS) to change the rules of the game for nabbing telehealth reimbursement. Watch More..
Ground-breaking changes to Evaluation and Management (E&M) documentation and payment are on the horizon, and the impact will vary widely depending on your specialty. Can you look forward to a pay bump—or a reimbursement reduction? Read on to find out. The scoop: CMS recently released More..
Your hospital’s Quality Assessment and Performance Improvement (QAPI) program is under more scrutiny than ever before. And with 86 percent of adverse events not reported to hospitals’ QAPI program, it’s no wonder that this is a major focus for the Centers for Medicare & Medicaid More..
Psychiatric hospitals and psychiatric units within general hospitals aren’t the only places that must comply with ligature risk-related safety regulations. Now, The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS) are cracking down on all hospitals and other healthcare settings to More..
Why are modifiers 25 and 59 causing so many billing and compliance problems lately? Payers are claiming that providers are frequently misusing these modifiers, which often leads to overbilling – a big no-no. Modifiers 25 and 59 are typically high-risk, with rampant misuse, and cause More..
A cardiologist leaves her practice and joins another, after which a former patient of hers comes to the new practice for an appointment: Do you bill the visit as a new or established patient visit? Many practices are puzzled by situations like this, says Terry More..