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Insights

Notes on reimbursement, audits, coding, and the rules that move a healthcare revenue cycle.

CMS Update
February 9, 2023
Major Changes to the Medicare Claims Processing Manual, Ch. 12
CMS issued Transmittal 11842 which brings about some significant changes to the manual. CMS is revising the following sections of the Centers for Medicare & Medicaid Services (“CMS”) Claims…
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Surprise Billing
February 1, 2023
What You Need to Know About Good Faith Estimates for Sliding Fee Discounts
Good Faith Estimates How do you comply with the No Surprises Act’s Good Faith Estimate (GFE) requirement if you’re a Federally Qualified Health Center (FQHC) or a provider or facility that offers…
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CMS MPFS
November 19, 2022
What You Need to Know About the 2023 Medicare Physician Fee Schedule Final Rule
Here are the highlights of the Centers for Medicare & Medicaid Services (CMS) updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B…
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Fraud
November 7, 2022
Facilitating 12,000 false claims costs chiropractor more than $15 million
Facilitating 12,000 false claims costs chiropractor more than $15 million We’ve all heard the admonition that if you didn’t code it, it didn’t happen. But what happens when it didn’t happen, but…
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Surprise Billing
November 1, 2022
The No Surprises Act – Partial Final Rule Effective October 25, 2022
In July 2021, the U.S. Departments of Treasury, Labor, and Health and Human Services [the Departments] released an Interim Final Rule, “Requirements Related to Surprise Billing, Part I”. In…
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Hospital
September 29, 2022
The OIG brings teeth to hospital price transparency
When it comes to hospital price transparency, CMS has thus far been ‘all bark and no bite.’ The agency mandated hospitals to make their prices readily available to consumers as of January 1, 2021.…
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August 1, 2022
CMS releases the FY 2023 hospital inpatient prospective payment system final rule
It’s that time of year again. On August 1, 2022, the Centers for Medicare & Medicaid Services (CMS) announced the release of its FY 2023 hospital inpatient prospective payment system (IPPS) final…
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Hospice
July 29, 2022
FY 2023 hospice payment rate update final rule solidifies payment increase and commitment to new patient assessment instrument
Beginning in FY 2023, hospice providers will see a payment increase of 3.8%, according to the FY 2023 hospice payment rate update final rule that the Centers for Medicare & Medicaid Services (CMS)…
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Hospital
July 27, 2022
FY 2023 inpatient rehabilitation facility PPS final rule ushers in updated Medicare policies that will yield higher payments
Inpatient rehabilitation facilities (IRF) will see updated Medicare payment policies thanks to the FY 2023 IRF final rulethat the Centers for Medicare & Medicaid Services (CMS) released on July…
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