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Medicare ICD-10 Coding Flexibility - How it Works Print E-mail
Written by Seth Flam, DO   
Wednesday, 05 August 2015 00:00
Early in July, at the urging of the AMA and other physician organizations, CMS agreed to offer flexibility with regard to ICD-10 coding during the first year of implementation: October 1, 2015 - September 30, 2016. In our July 6 blog post, we outlined the new rule - and a key component of that rule centers on claim denial "flexibility:"

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The Next Generation ACO Model Print E-mail
Written by Fred Segal | Broad & Cassel   
Saturday, 01 August 2015 15:34

After its first two "performance years," the Medicare Shared Savings Program (MSSP), established by the Affordable Care Act, and launched in 2012 by Centers for Medicare and Medicaid Services' (CMS) Center for Medicare & Medicaid Innovation, has  been met with mixed reviews. The MSSP was implemented in order to start incentivizing coordination and facilitation of care for Medicare fee-for-service beneficiaries between independent providers through provider participation in Accountable Care Organizations (ACOs). 

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CMS Proposes Stark Law Amendments - Is Stark Law a Barrier to Healthcare Reform? Print E-mail
Written by   
Sunday, 26 July 2015 13:25

The Centers for Medicare & Medicaid Services (CMS) recently published a notice of proposed rulemaking to amend its regulations implementing and interpreting the Stark Law. CMS also used this proposed rule to state its positions on certain questions of Stark Law interpretation and application, and to solicit comments from the industry on whether the Stark Law is a barrier to health care delivery and payment innovation, and whether the industry needs more guidance on how the Stark Law applies to physician compensation. Notably, the proposed rule adds two new Stark Law exceptions-one for financial assistance to practices to recruit primary care non-physician practitioners and one for "time-share" arrangements. Comments on the proposed rule are due September 8, 2015.

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Last Updated on Tuesday, 18 August 2015 11:23
CMS' fraud crackdown relies on high-tech analytics Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Thursday, 23 July 2015 12:26

The government's crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments.

Aptly named the "Fraud Prevention System," the program has identified or prevented $820 million in inappropriate payments in its first three years. In 2014 alone the Fraud Prevention System identified or prevented $454 million in fraudulent billing, according to CMS.

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The CMS ICD-10 Announcement: What It Means to Your Practice Print E-mail
Written by Mary Pat Whaley | Manage My Practice   
Friday, 10 July 2015 15:03

First, the game-changing announcement below means that a sigh of relief is in order. Some of the anxiety surrounding potential financial disaster should be abated. CMS announced:

"Medicare review contractors [MACs and RACs] will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family."

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