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Articles tagged with "Medicare"

Skilled Nursing Facility Patients—Consolidated Billing

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When treating a patient that lives in a skilled nursing facility (SNF), it is important to understand the coding and billing guidelines of consolidated billing. That is because certain services must be consolidated and submitted by the SNF using its Medicare provider number, and not submitted by you, the physician, unless they are one of the excluded services, which will be further discussed below.

Practice Page: Protecting Your Practice through Compliance

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Compliance programs are an effort by the government to maintain integrity in the healthcare system. These programs target activities causing improper payment to determine their root cause: Was it a mistake or error, was it inefficiency or waste of resources, is the provider bending the rules or abusing the system, or was it intentional deception or fraud? There are also laws dictating the compliance culture within practices and institutions; for example, red-flag rules, antikickback statute, and stark law, to name a few.

Stage 2 of the EHR Incentive Program

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Although reporting for Stage 1 of the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program began just this year, the rules, objectives, and measures for Stage 2 are already being established. Last June, the Office of the National Coordinator (ONC) for Health Information Technology (IT) presented CMS with its recommendations for Stage 2 of the CMS EHR Incentive Program which builds on the Stage 1 objectives supporting EHR utilization for data capture and sharing.

MUEs and Muscular Ultrasound Guidance: An Unlikely Story

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Medically Unlikely Edits (MUEs) were launched on January 1, 2007 by the Centers for Medicare and Medicaid Services (CMS) to reduce the paid claims error rate for Medicare Part B claims. The function of MUEs is to detect and deny unlikely CMS claims for a Medicare patient on a single, 24-hour date of service on a prepayment basis. This is achieved by limiting the frequency of services provided by a physician or medical supply company.

I Will Be the Squeaky Wheel

David Borenstein, MD  |  

Being the voice of rheumatology is critical to improving care for our patients

Meaningful Use and Patient Engagement – Supporting eHealth Literacy

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It is no surprise that understanding health information and navigating the U.S. health system can overwhelm even the savviest patients with advanced literacy skills. Data from the National Adult Literacy Survey suggest that nearly 50% of all adults have problems understanding many aspects of healthcare, including prescriptions, appointment slips, and health education materials.

ACR Talks to Congress about Physician Payment Reform

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This year, key congressional committees that oversee healthcare have held hearings on the flawed Sustainable Growth Rate (SGR) formula and are discussing various payment reform options. The ACR has submitted testimony to the key committees encouraging Congress to:

Coding and Billing Guidelines Overview and Resources

Melesia Tillman, CPC, CPC-I, CRHC, CHA  |  

Due to federal regulations and the variety of audits that now exist, the ACR has developed an overview of guidelines and identified a list of resources to keep handy to ensure all current guidelines are strictly followed.