Identifying the Acute Care Hospital Technical and/or Administrative Denial Reason

As discussed in the introductory article, a technical or administrative denial occurs in the acute care hospital setting when a […]

New COVID-19 Policies for Inpatient Prospective Payment System (IPPS) Hospitals Limits the 20 Percent Increase in Weighting Factor for COVID-19 DRGs

On August 17, 2020, CMS released a revised MLN Matters SE20015 to announce a change in the application of the […]

CMS to Resume Post Payment Audits

CMS has announced that to protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service […]

CMS Audits to Resume Even in the Midst of the Public Health Emergency

In case you missed it, CMS released the Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) updated [...]

CMS’s Prior Authorization Process and Requirements for Certain Outpatient Hospital Department Services

CMS will begin the process of requiring prior authorization for certain outpatient hospital department services starting July 1, 2020. Certain [...]

Prior Authorization Process and Requirements for Certain Outpatient Hospital Department Services Special Open Door Forum

Thursday, May 28 from 1:30 to 3 pm ET CMS invites hospitals, physicians, practitioners, and other Medicare stakeholders to discuss [...]

Original Medicare (Fee-for-service) Appeals Enhanced Opportunity for Submission of 2nd Level Appeals, Reconsiderations

Qualified Independent Contractors (QICs) that process 2nd level Medicare Fee-For-Service (FFS) claim appeals, reconsiderations, on behalf of the Centers for […]

Billing “Incident To” PT, OT and SLP Services Furnished via Telehealth During COVID-19 Pandemic

Did you know there is a very strong argument you can bill PT, OT and SLP provided via telehealth as […]

Appeal Rights for Observation Status for Certain Medicare Beneficiaries

In a case that took almost nine years to decide the United States District Court, District Court of Connecticut issued […]

How well are Statutory Documentation Requirements Decreasing CMS Program Risks?

The Government Accountability Office (GAO) issued a report on March 27, 2019, stating CMS should assess documentation necessary to identify […]