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MACRA Compliance MIPS Eligibility

MACRA Compliance Step 1: Check Your MIPS Eligibility

Get ready — MACRA is definitely going live Jan. 1, and will most certainly have a huge impact on your claims payments. Before you jump on the MACRA bandwagon, you need to make sure that the program really applies to you. The Centers for Medicare and Medicaid Services (CMS) recently announced that it would release […]
Medicare Payment Rate

Medicare Releases Your 2017 Payment Rate Based on PQRS and QRUR Data

On Sept. 26, the Centers for Medicare and Medicaid Services (CMS) made available for download your 2015 Physician Quality Reporting System (PQRS) Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRUR). These reports lay out your positive, neutral or negative payment adjustments under the PQRS and Value-Based Modifier programs, respectively, for your 2017 […]
ICD-10-CM Code

Laterality Frequently Unlocks ICD-10-CM Code Accuracy

To get your claims reimbursed, payers demand that you be as specific as possible with your ICD-10-CM code assignment. Often this means you must identify laterality and accurately adjust your coding to avoid claim denials and payer audits. When CMS implemented ICD-10, the number of diagnosis codes went from 14,000 to 68,000 — a massive jump. […]
MACRA Compliance

CMS Offers 4 Options for First Year MACRA Compliance

UPDATE: In response to CMS Acting Administrator Andy Slavitt’s Sept. 8 announcement that the agency would not delay MACRA implementation, leaders of the U.S. House Energy and Commerce Committee and Ways and Means Committee issued a statement Sept. 9 indicating that they were pleased that CMS was moving forward with options for compliance with the […]
60-Day Rule Timeline

Avoid Tripping Over the 60-Day Rule Timeline … Know When to Start the Clock

The relatively new 60-Day Rule affects all Medicare and Medicaid providers regardless of specialty, size or type, and nailing down the exact date to begin your 60-day countdown is one of the most confusing compliance aspects — although other rule components can easily trip you up as well. The rule may seem straightforward — you […]
HIPAA Breaches

HHS Targeting Smaller HIPAA Breaches

Beginning in August, the U.S. Health and Human Services Department (HHS) Office of Civil Rights (OCR) launched a new initiative to investigate smaller breach reports — meaning those that affect fewer than 500 individuals, the agency announced Aug. 18. This effort is based on a series of recent case settlements where OCR investigated smaller breaches […]
1,212 Injury Diagnosis Codes Changes

Make the 1,212 Injury Diagnosis Codes Changes Work for You

On Oct. 1, not only will your ICD-10 grace period end, but you also will have 1,212 injury code changes to comply with. That means you have no time to procrastinate, and you must ensure you’re ready … or you could be facing hefty denials. Almost every healthcare provider reports injury ICD-10 codes. And these […]
Medicare Overpays

Medicare Overpays Billions on E/M Claims

According to a May 2014 report based on 2010 data, HHS is claiming Medicare overpaid $6.7 billion in E/​M payments to providers. The Inspector General’s report, released on May 29, 2014 estimates that 21% of the $32.3 billion spent on E/​M services in 2010 are overpayments.  This data is based on 657 Medicare claims. Although […]
ICD-10 Test Claims Submitted

CMS Accept 89% of ICD-10 Test Claims Submitted

On June 2, 2014, CMS Acting Director, Niall Brennan, posted some exciting ICD-10 testing results to the CMS website. In summary, based on 2,600 participants, CMS accepted 89% of the more than 127,000 claims that were submitted with ICD-10 diagnoses. Brennan also posted that, “HHS expects to release an interim final rule….that would require the […]