#CMS

Mar 29, 2018
2 min

OIG Audit Finds 61% Of Medicare Claims For Outpatient PT Noncompliant

What would we do without the Centers For Medicare & Medicaid Services? More commonly known as CMS, the collection of the health insurance programs (which are Medicaid, Medicare, and the Health Insurance Exchanges) pledges to put patients first. “We must empower patients to work with their doctors and make health care decisions that are best for them,” reads the CMS website, “This means giving them meaningful information about quality and costs to be active health care consume

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Aug 23, 2017
3 min

OIG Issues Largest EMTALA Fine In History Of The 31 Year-Old Law

In 1986, the federal government enacted the Emergency Medical Treatment and Labor Act. Known as EMTALA, for short, it’s a law that requires anyone who comes into a hospital emergency room to be treated, regardless of their insurance status or ability to pay. “Referred to as the ‘anti-dumping’ law, it was designed to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without, at a minimum, providing a medical screening examination to ensure

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$Alert: Proposed CMS rule for coordinated cardiac and hip fracture care$

Jul 26, 2016
5 min

Alert: Proposed CMS rule for coordinated cardiac and hip fracture care

CMS released yesterday that it plans to expand the CJR (Comprehensive Joint Replacement) bundled payment system to include not only additional hip and femur DRGs, but also AMI (Acute Myocardial Infarction) and CABG (Coronary Artery Bypass Graft) DRGs. This is an ongoing progress from CMS to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care at a lower cost. Just like with the CJR bundle, the risk will be phased

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Jul 25, 2016
3 min

CMS Projections of National Health Expenditures Data Released

Office of the Actuary in the Centers for Medicare & Medicaid Services released its annual projections of health care spending for categories within the National Health Expenditure Accounts (NEHA). The latest projections begin after the latest historical year (2014) and go through 2025. An article about the study was also published by Health Affairs. The summary from the CMS news release on July 13th states that: Total health care spending growth is expected to average 5.8 pe

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Jul 20, 2016
1 min

Alert: CMS IRF and LTCH Quality Reporting Training in August!

CMS posted that registration is open for in person provider training for both rehabilitation and long-term hospital providers. Inpatient Rehabilitation Quality Reporting Program Provider Training – August 9th & 10th, 2016 – CMS is hosting a 2-day, in-person training event on August 9 and 10 for the Inpatient Rehabilitation Facility (IRF) Quality Reporting program (QRP) in Chicago, IL. This training is for IRF providers, associations, and organizations. The objective is to pro

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Jul 1, 2016
1 min

2017 ICD-10-CM Update Released

Yep, the updated ICD-10-CM and PCS code sets are posted! Fast Facts: 1,943 new codes, 351 revised codes, and 313 deleted codes. 2017 Code changes go into effect with discharges or patient encounters on or after October 1, 2016. There is no grace period. Updated ICD-10-CM Official Guidelines for Coding and Reporting as well as POA Exempt List will be coming soon. The Fiscal Year 2017 General Equivalence Mappings (GEMs) files will be posted in August. Click here for 2017 PCS co

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Jun 30, 2016
2 min

Move over CJR…Here comes OCM!!!

CMS implemented the Comprehensive Care for Joint Replacement (CJR) bundled reimbursement as of April 1st, 2016, and there are still more innovations coming! The CMS innovation Center announced on July 29th that nearly 200 physician groups and 17 insurance companies will be participating the five year oncology coordinated care initiative, known as the Oncology Care Model. This patient centered care model is designed to improve quality of care, increase the coordination of care

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Jun 2, 2016
3 min

CMS In Hot Water For Inability To Stop Medicaid And Medicare Abuse

At Allegiant Experts, we wholeheartedly believe that we side with what’s right. It is right that Americans have access to much needed healthcare, especially when they endure unexpected, dire situations. It is also right that Americans are treated by experienced and knowledgeable physicians who have dedications towards providing better health and safety to their communities at large. This is why it is with great disappointment that we recently learned of the Centers for Medica

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May 26, 2016
1 min

CMS releases new ICD-10 Resources

The Centers for Medicare & Medicaid Services (CMS) has released updates to the ICD-10 Provider Resources page. Please check out the Clinical Concept Series to familiarize yourself with ICD-10 codes and clinical concepts. CMS has posted the ICD-10 Clinical Concepts Series with tailored guidance for: Family Practice Internal Medicine Cardiology OBGyn Othopedics Pediatrics Each guide, posted by CMS, contains 4 key ares to help clinicians and codes locate information about ICD-10

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May 24, 2016
1 min

New bill would expand the scope of who can be excluded due to healthcare fraud

US House of representatives Lois Frankel (D-Fla.) and William Keating (D-Mass.) introduced a bill to amend title XI of the SSA to expand fraud fighting efforts on May 18th. The bill would let the OIG (Office of the Inspector General) exclude individuals from healthcare programs if they are affiliated with an organization that has been penalized for certain types of medical fraud. This means that executives of a company found to be engaging in fraudulent activity cannot avoid

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Apr 4, 2016
3 min

The Comprehensive Care for Joint Replacement (CJR) Model is here!

Medicare has implemented the Comprehensive Care for Joint Replacement (CJR) Model as of April 1st, 2016! Yep, as if the DRG system and calculation of the payments was not confusing enough, now MS-DRGs 469 and 470 just got more interesting. In an attempt to increase the quality, efficacy and cost of care, Medicare is bundling payments for an episode of care to incentivize hospitals, physicians, rehabilitation facilities, manufactures and other providers to work together. Patr

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Feb 29, 2016
3 min

Readmission Rates are Down?

Is the Hospital Readmission Reduction Program (HRRP) reducing hospital readmission rates? The New England Journal of Medicine published a special article this week which they address four hypotheses of why hospital readmission rates have dropped from 21.5% in 2007 to 17.8% in 2015. The authors stated that “Despite the importance of readmissions, there has been little study of the effect of the program. Published epidemiologic data suggest that overall national rates of readm

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