A few weeks ago, the Office of Medicare Hearings and Appeals (OMHA) announced what it described as a way to clear up the current federal backlog of appeals and move the process forward more efficiently. Of particular interest is the Statistical Sampling Pilot Program. Also of some interest is that the Centers for Medicare & Medicaid Services (CMS) has been conducting statistical audits for the past umpteen (I love that number) …Read more
I am opposed to the Eighteenth Amendment to the U.S. Constitution, which prohibits the manufacture, transportation, and sale of alcohol. I think that prohibition has done more harm than good and that alcohol should be legal to sell and consume in the United States. I therefore call on Congress to hold hearings on repealing the Eighteenth Amendment. Oh, wait, it was repealed in 1933. So I guess there is no reason …Read more
We all know what we went through during sequestration last year. As if the cuts were not enough, we had the accounting nightmare of what to do with the related deductibles and coinsurance differences. Adding insult to injury, your Medicare Advantage (MA) plans followed suit and reduced their payments. You have to scratch your head and wonder if that makes sense (in most cases, no, it doesn’t). You also may have …Read more
EDITOR’S NOTE: A call-in by a listener to Monitor Mondays last Monday has prompted this special bulletin. So you know you are audited, you even know they are RAC audits, but what are you doing about it? How are you tracking what is audited, recouped, overturned, etc.? It is imperative that you are tracking every facet of every audit. When you receive...Read more
The Centers for Medicare & Medicaid Services (CMS) signed contracts last week with the incumbent RAC contractors to provide limited Recovery Audit services through April 30, 2016, according to Monitor Mondays legislative analyst Emily Evans. Evans, a partner with the Obsidian Research Group, said the contracts, valued at around $200,000, would be for limited RAC services. “RACs will be permitted to handle...Read more
In a June 19 article I wrote for RACmonitor titled “Four Myths about IPPS Best Practices – And Why You Shouldn’t Believe Them,” I noted that one of the most common misconceptions in our industry is that there will be no more audits until April 1, 2015 at the earliest – or, as some are even thinking, that audits are...Read more
Earlier this month RACmonitor informed us of the new U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) release encouraging the Centers for Medicare & Medicaid Services (CMS) to place more scrutiny on evaluation and management (E&M) services, with the suggestion based on the staggering statistics surrounding improper payments for these services. E&M services often are selected...Read more
Every Monday on Monitor Mondays, the inimitable David Glaser, Esq. energizes listeners with his legal interpretation of healthcare's thorniest rules and regulations, during the broadcast's popular segment "Risky Business." Now you can hear 60 minutes of David Glaser as he and his colleague, attorney Katie B. Ilten, answer many of the most common questions from hospitals and clinics—including yours—in a special webcast.
| RACmonitor.com, a division of Panacea Healthcare Solutions, Inc.
287 East 6th Street | Suite 400 | St. Paul, MN | 55101 • TOLL FREE: 800.252.1578