Radiology Audits: A New Pilot Program from CMS

This is the all too familiar scenario.  An order for radiology services is received, the [...]

The Audit Gates Have Opened Wider

The Centers for Medicare & Medicaid Service (CMS) has approved eight new Recovery Audit Contractor [...]

Effective 9/8/20: AMA Issues 2 New COVID CPT® Codes

The American Medical Association (AMA) issued two new CPT® codes effective September 8, 2020.  The [...]

COVID-19 DRG with Enhanced Payments to be Audited

As part of the public health emergency CMS added increased weighted reimbursement to COVID-19 DRGs.  [...]

Specialty Care Transports (SCT): CMS Medical Necessity and Documentation Audits

Centers for Medicare & Medicaid Services (CMS) recently approved Recovery Audit Contractors (RACs) to audit [...]

The 2021 Proposed Physician Fee Schedule: The Major Points

On August 3 CMS published the proposed policy changes for the Physician Fee Schedule (PFS).  [...]

Home Infusion Billing Changes: What you need to Know

CMS announced several changes in Transmittal 10269 regarding billing home infusions effective January 1, 2021.  [...]

Inpatient Claim Audits in Center Focus with HHS-OIG

Inpatient audits once again take center stage with the Centers for Medicare & Medicaid Services [...]

E/M Changes are coming – Are you Ready?

Historic changes are coming to evaluation and management (E/M) codes effective January 1, 2021. The [...]

Spotlight on Nursing Home Compliance

Nursing homes have long been in the headlines for quality of care issues in some [...]