63 Billing and Coding Strategies for
Avoiding Medicare False Claims


Get indispensable help in avoiding Medicare billing and coding pitfalls that could subject you to very costly and time-consuming enforcement actions or result in a loss of revenues to which you're entitled.

"63 Billing and Coding Strategies for Avoiding Medicare False Claims" is a comprehensive collection of practical articles on false claims cases, government billing and coding investigations, and a wide range of Medicare billing and coding problems to avoid.

Supplemented with sample forms and worksheets, the articles in this report will guide you around many of the most common pitfalls in Medicare billing and coding, cost report errors, bad documentation, DRG upcoding and other problems that can result in enormous fines and penalties against your organization.


For more information or to order your copy today, please visit:
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Table of Contents

  1. With CMS Move, Hospitals Face Money Loss for Multiple Push Injections of Same Drug
  2. CMS: Hospital Can Charge Unused Room, Board for No-Show Patients
  3. Proposed Rule Cracks Down on LTC Hospital Payments; Coding Errors Are Common
  4. Hospitals May Risk MSP Overpayments When Billers Misuse Certain Value Codes
  5. Value Codes Information for Hospital Billing
  6. Time Is Ripe to Improve Modifiers 25 and 59 Compliance; OIG Audit Cites High Error Rate
  7. Decison Trees for Proper Use of Modifiers 25, 59
  8. Billing Errors Include Not Proving Medical Necessity for Stents
  9. Reimbursement Status of Medical Nutrition Now Uncertain; CMS Throws Ball to FIs' Court
  10. Hospitals Face Difficulty as New CPT Codes Collide With C Codes for Billing Infusion
  11. Baylor's Expanded Review: 12 Risk Areas
  12. Billing for Medical Nutrition Therapy
  13. Allow One-Level Leeway in E/M Coding Differences
  14. New Condition Codes for Device Surgery May Signal CMS Reimbursement Concerns
  15. Processes for Provider Billing in Seven Situations
  16. Final OPPS Rule: CMS Drops Imaging Cuts, Simplifies Observation Services Billing
  17. One Expert's Observation Billing Tips
  18. CMS Fixes DRG Window Error; Providers Should Test Compliance
  19. Compliance Investigations Focus on Systems and Incidents; Look at Transfers, Drugs
  20. Sample Observation Policy, Procedure
  21. Documentation Stakes High with 12 New DRGs, MCVs; Pairs Pose Compliance Risk
  22. New Stroke DRG Pays More, but Be Wary of Compliance Risks
  23. Validating Discharge Status Codes
  24. Hospitals Grapple with Cardiac Medical Necessity; OIG Finds Stent Billing Errors
  25. Update Training, Policies to Ensure Drug Administration Compliance Amid Changes
  26. Monitoring Will Get Tougher for Hospitals; CMS Extends Transfer Policy to 182 DRGs
  27. DRGs Subject to Post-Acute Care Transfer Payment Policy
  28. CMS Will Pay More for Severe Cardiac DRGs to Level Playing Field
  29. CMS Changes Observation Game in 2006 OPPS Reg; Hospitals Will Be Happy to Play
  30. CMS Changes Imaging, Drug, Prevention Payments in OPPS Rule; No E/M Coding Yet
  31. With Some Inpatient Coding Still Weak, Look to Improve Oversight
  32. 'Expanded Review Strategy' Helps Improve Baylor's Compliance Monitoring in 12 Areas
  33. Auditing E/M Coding, Modifiers: Baylor's Activity Form
  34. Auditing E/M Coding, Modifiers: Baylor's Decision Tree
  35. Medicare Scrutiny Turns to DRGs with CCs, as Study Links CC Billing to Coding Errors
  36. Medicare Watchdogs Intensify E/M Coding Scrutiny; New Audit Sources Are Available
  37. Next Round of Hospital Payment Monitoring Program Is Set to Start, Has New Risk Areas
  38. Worksheet to Help Hospitals Monitor OPPS Drug Billing
  39. CMS Cracks Down on Billing for Physical Therapy 'Incident to' Physician Services
  40. CMS: CPT Codes Will Replace Q Codes for Hospital Drug Administration Under OPPS
  41. CMS Fund Is EMTALA Brass Ring; Hospitals Must Detail Illegal-Alien Status, Stabilization
  42. CMS: Apply Start, Stop Time Definitions to All Observation; Separate Medical, Surgical
  43. Interest Grows in Auditing Audits to Help Flush Out Errors, Improve Your Credibility
  44. Guard Against Ripple Effects of Bed-Use Changes; Watchdogs Eye Cost-Report Fraud
  45. Hospital's Nightmare Ends as Judge Rejects Fraud Allegations Related to Nurse Ratio
  46. Billing Guidance for Replacing Certain Medtronic Devices
  47. Hospital Gets Second Chance in Disclosure; Chart Review, Tools Cut Admission Errors
  48. Medicare Watchdogs Eye Radiology Pay; More Registration Controls Suggested
  49. CMS Revises APCs Again; Evolution of Observation Payment Continues
  50. Admission Medical-Necessity Errors Abound; Hospitals Try New Compliance Strategies
  51. CMS Implements 'Medically Unbelievable' Edits for Claims
  52. Septicemia, Sepsis Coding Errors Are Prevalent; Use PEPPER to Flag Problems
  53. OPPS, Ancillaries Stressed in OIG Guidance; Greater Compliance Oversight Necessary
  54. Sample Orders for Outpatient Services
  55. CMS Says Contractors Must Obtain More Documentation Before Denying Claims
  56. CMS Adds Minimum Time of Care for APC Observation Payment
  57. ASC Rules Have Hospital Implications; Track APC, ASC Pay Gaps for Same Procedures
  58. ASC vs. APC Pay: Analyze Payment Differentials for Same Procedures
  59. CMS Implements New System to Resolve Provider Billing Dilemmas
  60. Case Review Gives Hospitals Some Bites of Payment Apple If They Produce Records
  61. Some Medicare Auditors, Prosecutors Crack Down on Hospital Infusion Billing
  62. Hospitals Get More Leeway in Billing Multiple Infusions
  63. Hosptial OPPS Billing Is At Risk Over E/M Facility Fees, HCPCS Codes, Modifier 59

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Please reference this customer code when ordering: BCS0810H


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