tci Medicare Compliance & Reimbursement - 2012 Issue 21
Industry Notes:
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Article Overview
This industry notes article surveys several current reimbursement and compliance developments relevant to Medicare and Medicaid providers. It covers CMS payment updates for seasonal influenza vaccines, newly CLIA-waived laboratory tests, OIG enforcement and exclusion-list issues, hospice work plan priorities, and a study discussing palliative care in skilled nursing facilities. The piece is aimed at providers, billers, coders, compliance staff, and administrators who need a broad view of policy and oversight topics that may affect operations and documentation.
Why This Topic Matters
The article helps healthcare organizations track changes in payment, test classification, and federal oversight priorities that can affect claims processing, compliance risk, and care delivery planning.
Article Sections
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One State Just Says 'No' to OIG Recovery
Discusses an OIG recovery dispute involving a Medicaid home care provider and a state response to the federal findings.
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Vaccines Receive Booster Shots for 2013
Summarizes CMS seasonal influenza vaccine payment updates and the affected vaccine codes.
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Consider These Lab Tests Officially 'CLIA-Waived'
Reviews CMS updates classifying additional laboratory tests as CLIA-waived and notes the related modifier requirement.
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Here's Another Reminder To Check The OIG Exclusion List
Covers an OIG exclusion-list settlement, provider screening concerns, and related compliance findings from an OIG study.
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SNF Relationships Feature On Feds' Hospice Compliance Radar
Outlines hospice-related OIG work plan priorities involving nursing facilities, inpatient care, hospital transfers, and Medicaid reimbursement compliance.
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Focus For Some SNF Patients Should Be On Palliative Care
Summarizes a published study discussing palliative care considerations for Medicare skilled nursing facility patients.
What You Will Learn
- How current CMS and OIG updates may affect provider reimbursement and compliance priorities.
- Which seasonal influenza vaccine codes were highlighted in the CMS payment update.
- Which lab tests were newly discussed as CLIA-waived and the modifier associated with that status.
- What enforcement and exclusion-list issues were emphasized for providers serving Medicare and Medicaid populations.
- Which hospice and skilled nursing facility topics were identified as oversight and research priorities.
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Healthcare administrators
- Hospice providers
- Home health providers
- Skilled nursing facility staff
- Laboratory services staff
- Physician practices
Codes Discussed
Modifiers Discussed
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