Janelle Ali-Dinar, PhD | July 20, 2016

House Ways and Means Committee Advances Measure to Provide Rural Regulatory Relief

Question: How do you spell “rural regulatory relief?" Answer: By providing a permanent extension of the enforcement instruction on unreasonable supervision requirements for outpatient therapeutic services in critical access and small rural hospitals.  In what some are seeing as a wrong being addressed – if not finally righted – and at perhaps one of the most vulnerable times for healthcare in rural America in history, with nearly 30 percent of the country's …

Read more
David M. Glaser, Esq. | July 20, 2016

Avoid Hiring Black-and-White Thinking Compliance Professionals

In a recent article, I quoted Dave Mason to illustrate the point that it can be reasonable to question authority. At times, however, people make unreasonable challenges. An irrational employee is not only a huge frustration; they also present a major compliance risk. Many qui tam lawsuits being with an employee who mistakenly believe you are breaking the law but won’t listen to reason. While it is true that in most cases …

Read more
Ronald Hirsch, MD, FACP, CHCQM | July 20, 2016

HCCs: Higher Scores, Higher Capitation Snags Florida Doctor

Some loyal RACmonitor readers may recall that way back in November of 2014, I wrote a RACmonitor article entitled It’s All About the Money – When is a Doctor Not a Doctor?, about Medicare Advantage (MA) plans contracting with firms to send physicians and non-physician practitioners out to the homes of their enrollees to take a history and perform a physical examination in order to get documentation of medical conditions. …

Read more
07.13.2016
Off-Campus Provider-Based Operations: What CMS Believes Congress Intended
Off-Campus Provider-Based Operations: What CMS Believes Congress Intended

The OPPS (Outpatient Prospective Payment System) update Federal Register appeared in examination form on July 7, 2016. Section X.A., Implementation of Section 603 of the Bipartisan Budget Act of 2015 Relating to Payment for Certain Items and Services furnished by Certain Off-Campus Departments of a Prover, addresses what The Centers for Medicare & Medicaid Services (CMS) believes Congress intended. Note...

Read more
07.13.2016
What’s Good for the Goose… How CMS Handles Underpayment of Claims
What’s Good for the Goose… How CMS Handles Underpayment of Claims

I was giving a presentation recently on the Comprehensive Error Rate Testing Program, or CERT. This is a study conducted annually by the Centers for Medicare & Medicaid Services (CMS) that, in effect, measures the error rate found for claims that have been previously approved and paid by Medicare. For 2015, the CERT study reported on the findings of reviews for...

Read more
07.18.2016
MACRA Complexity Causes Even More Confusion and Uncertainty for Rural
MACRA Complexity Causes Even More Confusion and Uncertainty for Rural

EDITOR’S NOTE: Last Wednesday, CMS Acting Administrator Andy Slavitt told members of the U.S. Senate Finance Committee that his agency might delay the implementation of MACRA scheduled to rollout January 1, 2017. It is wheat harvest time in Rural America—a time when the amber waves of grain come full circle, when one hopes that the last several months of careful planting and...

Read more
07.20.2016
68-Percent Settlement Focus of Upcoming Town Hall Broadcast
68-Percent Settlement Focus of Upcoming Town Hall Broadcast

Andrew Wachler, Esq. Steven Greenspan, JD, LLM With hopes that the Centers for Medicare & Medicaid Services (CMS) might reopen the 68-percent settlement solution it once offered providers to expedite the appeal process, RACmonitor is producing a special-edition broadcast on the topic scheduled to air live at noon ET on Tuesday, Aug. 9.  The 60-minute, live “town hall” broadcast is being sponsored by...

Read more

Sponsors

Optum Executive Health Services offers solutions to support hospitals in achieving medical necessity compliance and financial integrity for both government and commercial payers.

Partners

Context4 Healthcare

Fredrikson & Byron, PA

Panacea Healthcare Solutions, Inc.

OIG

OIG Work Plan: Fair Warning

Chuck Buck | 11.04.2015

OIG Work Plan: Fair Warning

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) 2016 Work Plan comes with a warning: the OIG continues to be relentless in detecting and...

Read more

Feature Articles

68-Percent Settlement Focus of Upcoming …

Mark Spivey | 07.20.2016

68-Percent Settlement Focus of Upcoming Town Hall Broadcast

Andrew Wachler, Esq. Steven Greenspan, JD, LLM With hopes that the Centers for Medicare & Medicaid Services (CMS) might reopen the 68-percent settlement solution it once offered providers to expedite the appeal...

Read more

IRF

Nordian Posts Results of Recent Oregon P…

Angela Phillips, PT - avatar Angela Phillips, PT | 05.04.2016

Nordian Posts Results of Recent Oregon Probe Audit:  Once Again, No Surprises for IRFs in the Results

Last month, we discussed Noridian’s findings from the IRF Probe Audit for Arizona conducted from December 21, 2015, through March 3, 2016. At that time, we agreed to provide the...

Read more

Register for your FREE subscription to RACmonitor eNews, delivered right to your inbox.

Register Today!