News Updates

Dentists and Durable Medical Equipment

Medicare approves oral appliances as an accepted treatment for Obstructive Sleep Apnea. 

Lawsuit: Epic's Software Double-Bills Medicare, Medicaid for Anesthesia Services

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

Doctors Plead Guilty in Health Care Fraud Scheme

Updated: Apr 11, 2018 6:10 PM PDT

SAN DIEGO (CNS) - Two Tennessee doctors pleaded guilty in San Diego federal court Wednesday to participating in a health care fraud scheme that bilked TRICARE -- the health care program that covers United States service members -- out of more than $65 million by prescribing thousands of exorbitantly expensive compounded medications to patients that they never saw or examined.

Hospital Outpatient Billing, Coding, and Compliance

We have developed a conference for those that work in an outpatient setting within a hospital.

OUR CONFERENCES COVER YOUR MEDICARE & PRIVATE INSURANCE CHANGES AND UPDATES

~For More Information~Call (800) 669-3328

HIPAA COMPLIANCE

Fulfill HIPAA’s training requirements

FRAUD AND ABUSE

Vital information you must know

 AUDITING AGENCIES

What you need to know to protect yourself

CODING CHALLENGES

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

1/9/18

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.