View a replay of the the Navigating the Diabetes Self-Management Training (DSMT) Reimbursement Maze webinar. This replay will give you an overview of Diabetes Self-Management Training (DSMT) Coding and Coverage. Review practices for overcoming reimbursement obstacles faced by pharmacies, solo practices and other providers, along with ways to Improve Profitability of AADE programs.

Those of us who started in compliance many, many moons ago never thought we would be delving into process of care and patient experience (aka satisfaction) score data to assess compliance risk. And, it has been an eye-opening experience for us all.

Click her to see a replay of the Analysis of CMS's Proposed Rule on the Duty to Report and Return Overpayments webinar. On February 16, 2012, CMS published in the Federal Register its much-anticipated (and long-awaited) notice of proposed rule-making regarding Medicare provider and supplier obligations to report and return overpayments.

I always find it fun when we get an extra day in the year. I think you should spend it doing something extraordinary. This year, I had the pleasure of doing just that by attending the Healthcare Provider Executive Roundtable Focusing on Governance, Regulatory, and Risk Management Hot Topics. The event, sponsored by Deloitte and Wolters Kluwer Law & Business, featured a number of experts talking about the future of healthcare delivery in light of regulatory changes including the Healthcare Reform Laws.

Because the CMS Manuals are so critical to compliance, coding, reimbursement, and audit, it is important to understand what is going on with the manual format, transmittals links and changes. I hope this mini-tutorial helps.

CMS Publications

Medicare makes available on its website 2 publications: 1 - Transmittals, which are CHANGES to the Pub 100 "Internet Only" Manuals, or IOMs.2 - Copies of the CURRENT versions of the manual, broken down by Chapter, in PDF format.

On August 28, 2010, Wisconsin Physicians Service Insurance Corporation (WPS), FI 52280, published Radiopharmaceutical Agents #RAD-026 V2 Approved DRAFT LCD. This draft LCD is one of the first, if not the first LCD, that establishes medical necessity criteria by specific CPT code procedure(s) for radiopharmaceutical agent reimbursement. The draft LCD Indications and Limitations of Coverage and/or Medical Necessity section indicates that radiopharmaceuticals will be considered medically necessary when used with the procedures listed in Table 1 of this draft LCD.

We offer free training to all customers, and the first "Basic" training shows you how to use the system; additional classes cover coding, reimbursement and advanced research techniques.  Frequently, new users on the system want to know "Where do I find the fee schedules?" or "How can I tell what Medicare will reimburse them for a particular procedure, test?" or &qu

CMS published the 2011 Inpatient Prospective Payment System Proposed Rule on May 4, 2010.  This year's proposals include changes to the MS-DRG payment rates for 2011, clarification on provider aggreements and supplier approvals, new COPs (Hospital Conditions of Participation) for Rehabilitation and Respiratory care services, and accreditation requirements for Inpatient Psychiatric services for individuals under the Age of 21.

This year's rule is 472 pages, with additional data and files not included in the rule (published instead on the CMS website).

Questions, questions, some answers, but more questions as I reflect on the 2010 ICD-10 AHIMA Summit that I attended earlier this week. One of the big questions is are YOU ready for this big change in healthcare and have you started to PREPARE? ICD-10 will affect all aspects in healthcare (payers, providers, vendors, clearinghouses, third party administrators, independent laboratories, employers, and researchers) to name a few. 

The micro lab has numerous “add on” procedures that are routinely performed to complete the culture report. Frequently, add on charges are never captured. There are several reasons for this – some process driven (such as bill drop dates coming too soon for the completion of all testing) and human errors (not submitting charges in a timely manner). One BIG reason is simply because bacteria do not grow at the whim of human time lines.