CMS Archive

After years of Litigation, E/M Denials Persist

Notwithstanding years of litigation and multi-million dollar settlements, many healthcare providers continue to experience inappropriate evaluation and management service (“E/M”) denials. Earlier today, I spoke with a provider who had a well-founded complaint regarding his denials, so I want to take a minute to quickly review the basics. E/M is a visit or consultation provided

How to Earn Your Electronic Prescribing Bonus

In recent blogs, we focused on Congress’ carrot and stick approach to encourage e-prescribing. As we discussed, providers who implement e-prescribing could receive Medicare bonuses (above and beyond the Medicare fee schedule payments) equal to 2% of their annual Medicare collections. However, providers who do not implement e-prescribing will eventually see their reimbursements drop below

Electronic Prescribing: Medicare Bonuses and Penalties

While we have seen many news stories regarding H.R. 6331’s rollback of the scheduled 10.6% Medicare reimbursement cuts, there has been virtually no coverage regarding the bill’s groundbreaking provisions calling for Medicare bonuses for providers who adopt and regularly utilize electronic prescribing. Therefore, let’s take a few minutes to discuss some of the basics. H.R.

Congress Stops Medicare Cuts and Creates E-Prescribing Bonus

By a veto-proof, bipartisan majority, Congress has just passed H.R. 6331, which will rollback the 10.6% Medicare reimbursement cuts that were scheduled to become effective today and provide an incentive to physicians who adopt and utilize electronic prescribing technology. Background regarding the Scheduled Cuts The Centers for Medicare & Medicaid Services (“CMS”) final 2008 Medicare

Significant Health Law Developments

During the last twelve months, we’ve seen significant developments in health law. At today’s opening session of the annual meeting of the American Health Lawyers Association, we took stock of many of these developments, which include the following: Medicare Cuts Saga Continues to Unfold. On June 30th, we witnessed the latest chapter in the Medicare

CMS Offers EMR Users Sizable Bonuses

Your primary care practice could earn up to $290,000, over a five year period, if you adopt and actively use an EMR in coordination with the new Medicare Demonstration Project, which is designed to measure and showcase the quality care improvements that can result from the widespread use of interoperable EMRs/EHRs. Since this program has

Physicians Brace for Summer Reimbursement Cuts

Medicare reimbursements for healthcare providers will be cut by an average of 10.6% on July 1st and Congress may not be capable of rolling back these planned reductions in time to beat the deadline. As many physicians recall, the Centers for Medicare & Medicaid Services CMS”) final 2008 Medicare physician fee schedule included average cuts

Medicare Reimbursement Cuts of 10.6% Scheduled to Take Effect on July 1, 2008

As July approaches, the healthcare community is once again bracing itself for significant, scheduled Medicare reimbursement cuts.  Those who have been following the news or reading this blog for more than one year will agree with Yogi Berra that “it’s like déjà vu all over again.” Unless congress is able to intervene, Medicare physician reimbursements

CMS Proposes Doubling the Number of Non-reimbursable Hospital-Acquired Conditions

My August 13, 2007 blog discussed CMS’ then-groundbreaking move to deny reimbursement for seven hospital-acquired conditions including pressure ulcers, hospital falls, certain catheter-associated infections, air embolism as a result of surgery, leaving an object in during surgery, providing incompatible blood or blood products and mediastinitis following coronary bypass surgery. CMS has now announced that it

Medicare Authorizes Missed Appointment Charges

It is increasingly common for physicians to charge their patients a fee for missed appointments. For example, approximately 31% of MTBC’s clients routinely charge a missed appointment fee. Most of these providers charge approximately $25, while others charge as little as $15 or as much as $100 per missed appointment1. Until recently, there has been