Medicare Compliance & Reimbursement

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Complete Coverage of the Latest Medicare Compliance and Reimbursement News

As you start off yet another challenging year, you need to know how CMS’s new policies and rules for 2018 will affect your practice and your reimbursement. Whether it’s the Medicare Physician Fee Schedule, OIG target areas and monthly work plans, Conversion Factor changes, new Telehealth Code Options, or QPP updates that will affect your bottom line, knowing what the updates are will allow you to budget and plan effectively. 

But CMS isn’t your only worry! Since the first of the year, the OIG has levied substantial prison time, medical license revocation, and punitive fines in several high-profile casesMedically unnecessary treatment, upcoding, and Stark violations were among the reasons behind the stiff penalties. These were some of the fraud and abuse case highlights:

  • Fraud and Upcoding Net MD 13 Years in Prison, Millions in Returns
  • False Claims Suit Renders Massive $16 Million Judgment Against MRI Company
  • Long Prison Sentences Mark Illegal Opioid Distribution and Prescription Cases


And, OIG’s 2017 Semiannual Report recorded a plethora of criminal and civil suits, exclusions, and recoveries in the billions. Look at the breakdown for FY 2017, according to the report:

  • Recovered funds: The OIG recouped $4.13 billion in investigative recoveries.
  • Criminal actions: The federal watchdog found 881 individuals or entities guilty of crimes against HHS programs.
  • Civil actions: Civil suits were brought against 826 individuals or entities for fraudulent activities.
  • Exclusions: The OIG also banned 3,244 individuals and entities from participating in federal healthcare programs in the future.


This means you need to be careful if you want to avoid billing errors and stay off the OIG hit list. Missing a single update can cost you big money.

Don’t Worry — Medicare Compliance & Reimbursement Can Help!

Plus, CMS’s new program “Patients Over Paperwork” helps streamline your administration, but that doesn’t mean the QPP Year 2 will be any easier. In fact, MIPS reporting jumps from 90 days to a full year in 2018—are you ready to report your data on day one? Keep abreast of the latest updates and regulations today and avoid unpleasant payback requests tomorrow.

Let editor Kristin J Webb-Hollering arm you with the Medicare compliance and reimbursement information you need to stay informed, compliant, and profitable in 2018 and beyond. Just subscribe to our monthly newsletter: Medicare Compliance and Reimbursement.

TOPICS COVERED IN RECENT ISSUES OF Medicare Compliance & Reimbursement: 

  • Enforcement: Data Analysis Drives OIG's Biggest Takedown Ever
  • Compliance: Combat the 10 Most Common Claims Mistakes with This Expert Advice
  • Reimbursement: Know These 5 Important Dates to Keep Medicare Pay on Target
  • New Programs, Delays, and Reductions Feature in the 2018 Fee Schedule
  • Who Were the Winners and Losers in the 2018 Medicare Physician Fee Schedule?
  • Reimbursement: Know These MACRA Updates to Ensure QPP Year 2 Pay
  • Master Medicare Remittance Rules for Deductibles and Coinsurance
  • E/M Coding: Perfect E/M Claims with Advice from Part B MACs
  • Advancing Care Information: Find Out What's New in 2018
  • HIPAA: Ensure Internal Protocols Are Ironclad to Stamp Out PHI Exposure
  • Compliance: OIG Settlement Reveals Critical Need for EHR Vendor Vetting
  • Double-Check Appeals’ Requests and Jurisdiction, MAC Urges
  • Hospices Need Increased Physician Involvement, OIG Warns
  • OIG Continues to Hand Out Steep Penalties for Upcoding and False Claims
  • Non-Physician Practitioners: Append Modifier SA on NPP Claims Now or Risk Denials, One Private Payer Says
  • Keep on Top of the Medicare Card Number Transition
  • Keep Phishers at Bay in 2018 with These 7 Tips
  • And much more…


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