Ronald Hirsch, MD, FACP, CHCQM | July 22, 2015

Do Auditors Make Up their Own Rules?

Last week RACmonitor published my article on the transmittal published by the Centers for Medicare and Medicaid Services (CMS) that clarified the documentation requirements for home care services. A series of Open Door Forums created a great deal of confusion by providing contradictory information, and this change to the Medicare Program Integrity Manual has clarified CMS’ original intention to ease the burden on physicians and increase access to home care services …

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David M. Glaser, Esq. | July 22, 2015

The Only Inpatient Criterion: An Expected Two-Night Stay

On a recent Monitor Mondays broadcast discussing proposed changes to the two-midnight rule, one listener commented that a consultant expected patients to meet “inpatient criteria” as well as the two-midnight rule before an admission would be justified. Another asked, “Don’t we care about the ‘criteria’?” There remains widespread confusion about when Medicare inpatient admission is allowed. The answer is surprisingly simple. If the physician reasonably expects the patient to be …

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Andrew B. Wachler, Esq. and Jessica C. Forster, Esq. | July 08, 2015

CMS Announces Changes to the Two-Midnight Rule

 Last week, the Centers for Medicare & Medicaid Services (“CMS”) announced changes to the two-midnight rule affecting short inpatient hospital stays.  The changes, published in the Ambulatory Surgical Center Payment – Proposed Rule (“Proposed Rule”), follow repeated calls from industry professionals to either revise or completely discard the two-midnight rule for inpatient hospital stays on the basis that it removes critical clinical decision-making from the inpatient admission process.  While CMS disagrees with …

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07.08.2015
CMS Proposed Rule for OPPS: Who Will Audit the Rule
CMS Proposed Rule for OPPS: Who Will Audit the Rule

Thursday, July 2 proved to be a busy day for many people who were just getting ready to enjoy the long holiday weekend. The Centers for Medicare & Medicaid Services (CMS) came out with their 697-page proposed OPPS rule for comment. The proposed rule itself is open for comment until Aug. 31, 2015.  Normally, we would then receive the final rule...

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07.08.2015
CMS Announces Changes to the Two-Midnight Rule
CMS Announces Changes to the Two-Midnight Rule

 Last week, the Centers for Medicare & Medicaid Services (“CMS”) announced changes to the two-midnight rule affecting short inpatient hospital stays.  The changes, published in the Ambulatory Surgical Center Payment – Proposed Rule (“Proposed Rule”), follow repeated calls from industry professionals to either revise or completely discard the two-midnight rule for inpatient hospital stays on the basis that it removes critical clinical...

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07.08.2015
2016 OPPS Proposed Rule: CMS Rewrites Classic Novels
2016 OPPS Proposed Rule: CMS Rewrites Classic Novels

Last week, the Centers for Medicare and Medicaid Services (CMS) released the 2016 outpatient prospective payment (OPPS) proposed rule, CMS-1633-P. The OPPS rule is where we usually find new payment rates, additions and deletions to the inpatient-only list, and new ambulatory payment classification (APC) categories. As discussed in the 2016 inpatient prospective payment rule (IPPS), CMS also proposed changes to the...

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CMS

$1.3 Billion Paid by Centers for Medicar…

David M. Glaser, Esq. | 06.15.2015

$1.3 Billion Paid by Centers for Medicare & Medicaid Services Clouds True Scope of Payout

On Thursday, June 11 the Centers for Medicare & Medicaid Services (CMS) quietly announced that as part of its 68-percent solution, it had paid out about $1.3 billion to 1,900...

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Feature Articles

Surgeon Scorecard: Comparison is the De…

Frank Cohen, MPA | 07.22.2015

Surgeon Scorecard:  Comparison is the Death of Joy (Mark Twain)

Is your surgeon better than my surgeon? Even if that were true, with all the nuances involved in performing a surgical procedure and the infinite number of iterative complications that...

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IRF

CMS-13 Qualifying Diagnoses: Arthritis a…

Angela Phillips, PT - avatar Angela Phillips, PT | 03.04.2015

CMS-13 Qualifying Diagnoses: Arthritis as a Qualifying Condition

On Jan. 15, 2015 the Centers for Medicare & Medicaid Services (CMS) held a provider training call to address several key issues related to the IRF-PAI and the changes in...

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