Medicare Compliance & Reimbursement

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CMS plans to overhaul the existing federally-mandated EHR system that’s tied to Medicare reimbursement, improving patients’ access to their own health data. The streamlined policies suggest popular trends that reduce providers’ burdens. With the CEHRT updates, CMS proposes E/M-reporting changes, new EHR-focused QPP measures, and policies that promote the efficient sharing of data between patients and providers. Are you up to speed?

Plus, as 2018 updates continue, CMS homes in on 2019 changes that will significantly impact your reimbursement. Whether it’s Medicare regulatory reform, MIPS-reporting reductions, telehealth expansions, or NCCI edits  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 cases. Medically-unnecessary treatment, upcoding, opioid-prescription abuse, and significant violations under Stark, the AKS, and FCA were among the reasons behind the stiff penalties.

Caution: The provisions of the 2018 Bipartisan Budget Act also demonstrate the Feds commitment to aggressively pursue alleged fraud, waste, and abuse affecting federal healthcare programs. Are you aware of these Civil Monetary Penalty (CMP) changes?

  • CMP increases for improperly filed claims (civil): $10,000 to $20,000; $15,000 to $30,000; and $50,000 to $100,000.
  • Maximum penalty increases for providers to reduce or limit services to Medicare beneficiaries: $2,000 to $5,000; and $5000 to $10,000.
  • Criminal penalties for acts involving federal health care programs including but not limited to the Anti-Kickback Statute” were raised: $2,000 to $4,000; $10,000 to $20,000; and $25,000 to $100,000.

For false statements and representations, AKS abuses, and excess charges, the maximum sentences went from “not more than 5 years” to “not more than 10 years. 

And the fraud and abuse stakes continue to rise. Last year, the OIG expected to restore $4.13 billion from investigative recoveries — and the penalties were steep. Extra care is needed to avoid billing errors that lead to scrutiny, payback requests, and the OIG hit list. Missing a single update can cost you big money.

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

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 bi-monthly newsletter: Medicare Compliance and Reimbursement.

TOPICS COVERED IN RECENT ISSUES OF Medicare Compliance & Reimbursement: 

  • Data Analysis Drives OIG's Biggest Takedown Ever
  • Know These CMP Changes the Budget Act Bumped Up
  • MedPac to Congress: MIPS Needs to Go
  • Combat the 10 Most Common Claims Mistakes with This Expert Advice
  • 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?
  • Know These MACRA Updates to Ensure QPP Year 2 Pay
  • Master Medicare Remittance Rules for Deductibles and Coinsurance
  • Make Light Work of Bundling Edits with This CCI Advice
  • Get Ready for These Medicare Overhauls
  • Perfect E/M Claims with Advice from Part B MACs
  • Advancing Care Information: Find Out What's New in 2018
  • Ensure Internal Protocols Are Ironclad to Stamp Out PHI Exposure
  • 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 Phishers at Bay in 2018 with These 7 Tips
  • And much more…

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