Industry Notes

Why This Topic Matters

The topics discussed affect Medicare reimbursement, reporting compliance, and fraud exposure. Practices that rely on quality reporting or that are preparing for ICD-10 transition guidance may need to review their workflows and payer-specific instructions.

Article Sections

1. CMS Reminds Practices How to Avoid PQRS Pay Cut in 2015

   Overview of Medicare quality reporting changes and timing considerations for eligible professionals. Discusses participation options and the general process for avoiding payment adjustments.

2. CMS Refers ICD-10 Date-Span Questions To Local MACs

   Summarizes a CMS FAQ response about claims spanning the ICD-10 implementation date and the role of payer-specific guidance. Focuses on transition-related billing and administrative questions.

3. ‘Mobile’ Physician Service Charged With Fraud

   Describes an enforcement case involving physician services, home visits, and alleged billing improprieties. Highlights the compliance and legal risks tied to fraud allegations.

4. Even An Office Manager Can Face Prison Time For Medicare Fraud

   Covers a fraud sentencing involving a non-physician staff member and large Medicare and Medicaid claims. Emphasizes that compliance exposure can extend beyond clinicians.