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Medicare Compliance & Reimbursement

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Stay compliant with Medicare requirements and profit from strategies to conquer escalating reimbursement pressures.

CMS is committed to reducing improper payments. In fact, they’re doing just that. The improper payment rate for fee-for-service (FFS) Medicare dropped from 9.5% in 2017 to 8.1% in 2018. Still, federal agencies find the $31.6 billion cost of 2018 improper payments disturbing.

What does this mean for your practice? Expect heightened scrutiny for top claim errors, such as insufficient documentation, incorrect coding, and failure to establish medical necessity.

To up the ante, policy changes for QPP Year 3 will make earning your MIPS incentive pay challenging — to say nothing of the learning curve these changes impose.

But CMS isn’t your only concern! The OIG has expanded its laundry list with intent to scrub away the prevalence of medically-unnecessary treatment, upcoding, opioid-prescription abuse, and violations under Stark, the AKS, and FCA — with threat of prosecution potentially leading to a debilitating settlement or stiff punitive fines, including medical license revocation and prison time.

Are you aware of Civil Monetary Penalty (CMP) hikes?

  • 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: $2,000 to $4,000; $10,000 to $20,000; and $25,000 to $100,000.

Too much is at stake to go it alone.

Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format.

Your bi-monthly subscription to TCI’s Medicare Compliance & Reimbursement Alert will also equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

Rely on our domain experts, led by editor Kristin J Webb-Hollering, to keep you in the know and arm you with game-changing guidance to defeat the challenges that threaten your claims and compliance success.

Say goodbye to compliance liabilities and subpar reimbursement with articles like:

  • Get Ready for More MIPS Revamps in 2019
  • Check Out What’s New in Virtual Care for 2019
  • Review This Q & A on Collecting for 5 Basic Services
  • Institutional Providers See $17 Increase for Medicare Enrollment Fee in 2019
  • Don’t Panic — OCR Updated Phase 2 HIPAA Audit Details
  • Anthem’s HIPAA Settlement With OCR Biggest in History
  • Reimbursement: Stay on Top of These Upcoming CMS Deadlines
  • Know the 5 Facts That Impact All New Medicare Providers
  • OIG Updates the Work Plan with 8 New Items
  • Use CMS-855O Form for Unlicensed Residents ASAP
  • Check MAC Rules for Non-Reimbursable Postoperative Visit Submissions
  • Review this HIPAA Violation and Penalty Primer
  • OIG Plans to Target MA Claims
  • Boost Your Bottom Line with Low-Cost HIPAA Protections
  • Know the 5 Facts That Impact All New Medicare Providers

Exclusive, Specialty-Specific Extras Included in Your Subscription

As a Medicare Compliance & Reimbursement Alert subscriber, you’ll also receive these resources at no additional cost:

  • SuperCoder’s Specialty Alert Archive
    E-Subscription and E-Subscription + Print subscribers will get unlimited access to a keyword-searchable database on, where you can find solutions to plaguing dilemmas covered in archived issues of Medicare Compliance & Reimbursement Alert. This is a $249.95 value!
  • SuperCoder’s Webinar Archive (6 AAPC-approved CEUs)
    Grow your skill set as TCI’s domain experts walk you through the top challenges and code changes with unlimited access to our webinars!
  • Up to 24 AAPC-approved CEUs per year
    Meet your annual CEU requirements without added expense. You’ll earn up to 6 more CEUs by passing short quizzes, as well as another 12 CEUs by subscribing to our FREE biweekly coding newsletter, SuperCoder Bolt. In total, that’s 24 AAPC-approved CEUs!

PLUS — We’re so confident your subscription will pay for itself many times over that we stand behind it with our 100% Money-Back Satisfaction Guarantee.

SUBSCRIBE ONLINE or call (800) 508-2582 to begin your subscription.
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