Medicare will soon begin replacing beneficiaries’ social-security-based Health Insurance Claim Number with new randomly-assigned Medicare Beneficiary Identifiers (MBI) to help protect against fraud and identity theft. Congress mandated the change through the Medicare Access and CHIP Reauthorization Act (MACRA) with an April 2019 deadline. READ MORE
Beginning August 1, 2016, penalties under the False Claims Act have almost doubled. READ MORE
The Office of Inspector general is recommending that the Centers for Medicare and Medicaid Services (CMS) eliminate the “provider-based facility” place of service designation because there is no reliable way to track or audit payments or potential overpayments. READ MORE
In a recent ICD-10 Monitor article, Bonnie Cassidy, vice president of consulting for Precyse MedAssets, claimed that the best way to get a handle on the growing number of denials under ICD-10 is for various players along the revenue cycle to “work collaboratively to design and deploy … a new pre-bill review process.” READ MORE
Starting April 18, 2016, Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) conducting redeterminations and reconsiderations of denied claims must limit their review to the reason the claim or line item at issue was initially denied. READ MORE
The Health and Human Services Office for Civil Rights (OCR) has begun its Phase 2 Audits of covered entities and their business associates under the HIPAA Privacy, Security and Breach Notification Rules. READ MORE
On Friday, January 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released the 2014 Work Plan outlining key priorities in overseeing the health and welfare of the country. READ MORE
This two-part series focuses on the recent report by the Center for Public Integrity which revealed a growing trend in billing for higher level Medicare patient visits among doctors. READ MORE
