Centers of Medicare & Medicaid Services [Healthcare Compliance Tips]

Bookmark the Centers for Medicare & Medicaid Services (CMS) site.

In our series called The Comeback Story: 9 Compliance Resources to Level Up Your Practice, I have been sharing essential resources that any practice can utilize to build an effective compliance program.

Resource number six is: 

Centers for Medicare & Medicaid Services (CMS)

Purpose:

CMS is part of the Department of Health and Human Services (HHS).  They administer programs such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the Health Insurance Marketplace, etc.

Goal: “To achieve a high-quality health care system, we aim to have better care at lower costs with improved health.”

How to Use It:

CMS is the heart of coverage, quality, billing, coding, and more. Even commercial insurance companies follow their guidelines. My three favorite sections are:

Regulations & Guidance

• This tab covers several areas, and the “Quarterly Provider Updates” section is the most useful. This section discusses topics such as regulations, major policies completed or cancelled, and new/revised manual instructions. At the bottom of this section, you can click on “CMS Quarterly Provider Updates Email Updates”. Clicking on this makes it easier for providers to keep track of the changes that occur.

Research, Statistics, Data & Systems

• Anything in this section is useful (based on the dates). The statistics and research section is especially important because you can compare the results with your practice.

Fact Sheets

• This section is dated, and provides updates through the fiscal year. The sheets give both the ins and outs of what is currently occurring within CMS.

Although, you may not use CMS’s resources, bookmarking their site and signing up for their mailing list is extremely important to receive compliance updates.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify and tailor the advice to fit your specialty.

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