News Updates

Consequences for HIPAA Violations Don’t Stop When a Business Closes

A receiver appointed to liquidate the assets of Filefax, Inc. has agreed to pay $ 100,000 out of the receivership estate to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) in order to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

How the Government Shutdown Affects Your Medicare Billing

During the time that the partial government shutdown is in effect, Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payment.

CMS announces new payment model to improve quality, coordination, and cost-effectiveness for both inpatient and outpatient care


Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.

Jauary 2018 Release Dark Days for the Common Working File Hosts

In anticipation of the January 2018 Release, the CWF Hosts will not process claims beginning Friday, 12/29/2017 through Sunday, 12/31/2017. During this period, which is commonly referred to as "dark days," the CWF Hosts will install the January 2018 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. Note: On Monday, 1/1/2018 the onlines will be available for HIMR, BDS and the MBI/HICN crosswalk, but no CWF cycles will be run.

2017/2018 MIPS Exclusions

Extreme and Uncontrollable Circumstances Over the past several months, numerous clinicians have been affected in many areas of the country due to Hurricanes Harvey, Irma, and Maria, which occurred during the 2017 MIPS performance period.

CMS addresses  extreme and uncontrollable circumstances for both the transition year and the 2018 MIPS performance period in this final rule with comment.

Lawsuit: Epic's software double-bills Medicare, Medicaid for anesthesia services

Health IT giant Verona, Wis.-based Epic Systems has been hit with a False Claims Act lawsuit that alleges the company's software double-bills Medicare and Medicaid for anesthesia services, resulting in the government being overbilled by hundreds of millions of dollars.

Houston, TX Conference Attendees

Dear Attendees,

Due to Hurricane Harvey and its impact on Houston and the surrounding area, we will be rescheduling our upcoming conferences.

Our "Local Dental Insurance Coverage, Changes, and Updates" conference originally scheduled for 9/8/17 has been rescheduled for 11/3/17.

Our "New Medicare Changes~ MACRA, Billing, Coding & Compliance" conference originally scheduled for 9/15/17 has been rescheduled for 10/20/17. 

We will send you final details once everything is confirmed.

End to SPRs Coming!

Beginning January 2, 2018, Medicare's Shared System Maintainers (SSMs) must eliminate issuance of Standard Paper Remittance Advice (SPRs) to those providers/suppliers (or a billing agent, clearinghouse, or other entity representing those providers/suppliers) who also have been receiving Electronic Remittance Advice (ERA) transactions for 45 days or more.  

Healthcare groups urge CMS to count Medicare Advantage contracts as APMs in MACRA

Citing Medicare Advantage contracts' role in improving quality and cost in healthcare, groups representing doctors, hospitals and accountable care organizations are pressing the Centers for Medicare and Medicaid Services to essentially treat those contracts as alternative payment models.

That step, they say, would keep Medicare Advantage relevant, to the benefit of patients in the Medicare program.

Feds file another suit against UnitedHealth, detailing allegations of fraud

The federal government Tuesday fleshed out its allegations about alleged Medicare Advantage fraud by UnitedHealth Group, filing another lawsuit against the insurer.

Justice Department attorneys contend UnitedHealth engaged in a subterfuge since at least 2005 that gave the Minnetonka-based company over $1 billion in payments to which it was not entitled.