Ronald Hirsch, MD, FACP, CHCQM | March 18, 2015

New Guidance on Pacemakers Comes with Needless Modifier

Last month the Centers for Medicare and Medicaid Services (CMS) released MLN Matters MM9078 along with change request 9078 that specifies the coverage and coding for permanent pacemakers which has been in flux for the last 18 months. CMS has now established July 6, 2015 as the date on which all claims for pacemakers must include the –KX modifier. But the history of this modifier and the coverage determinations for pacemakers …

Read more
Shannon Deconda, CPC, CPC-I, CEMC, CMSCS, CPMA® | March 18, 2015

Giving Clarity to the Ambiguity of E/M Services

  Evaluation and Management (E/M) services have many gray areas from an auditing standpoint, yet they continue to represent a top audit target for payers and the government.  The documentation guidelines for E/M services are now 20 years old and have seen no significant changes. What has changed, however, is how the medical record is created, analyzed, and scored.  What we have been left with are guidelines that are suggestive in nature and …

Read more
Andrew B. Wachler, Esq. and Jessica C. Forster, Esq. | March 18, 2015

Contradictory Guidance Issued for Home Health Agencies Revealed

  Pursuant to the calendar year (CY) 2015 Home Health Final Rule published by the Centers for Medicare & Medicaid Services (CMS) on Nov. 6, 2014, effective Jan. 1, 2015 new rules for home health agencies face-to-face encounter documentation were implemented.  One of the most notable revised rules was the elimination of the brief narrative requirement in almost all cases for home health face-to-face encounter documentation.  The home health industry accepted this …

Read more
02.04.2015
Everyone's a Critic – Except When it Comes to Themselves
Everyone's a Critic – Except When it Comes to Themselves

One of the objectives of the Centers for Medicare & Medicaid Services (CMS) is to move away from fee-for-service healthcare and toward pay-for-performance. But the road to pay-for-performance has not been a smooth one. The initial accountable care organization (ACO) program design was flawed, with ACOs held financially responsible for the yearly expenses of a “mystery cohort,” a group of beneficiaries...

Read more
02.04.2015
What Does "Status" Really Mean? A Provider's Perspective
What Does "Status" Really Mean? A Provider's Perspective

Here it is January 2015, and we are still struggling with a rule put in place back in October 2013. The reasons behind the struggles vary from hospital to hospital but have a resounding theme behind most of them. If only the Centers for Medicare & Medicaid Services (CMS) could be clear in its definition of inpatient versus outpatient, we...

Read more
02.04.2015
Some Tips for Dealing with the Early Phases of an Audit
Some Tips for Dealing with the Early Phases of an Audit

The following are a few practical tips for responding when you get a request for medical records from Medicare or a private insurer.   First, make sure that whoever is opening the mail keeps the envelope. It is relatively common for the date on a letter and the date of the postmark to be extremely disparate. In one case, a letter dated...

Read more

CMS

CMS Releases Proposed Voluntary Face-to-…

Andrew B. Wachler, Esq. and Jessica C. Forster, Esq. | 02.18.2015

CMS Releases Proposed Voluntary Face-to-Face Templates for Certifying Physicians

  In January 2015, the Centers for Medicare & Medicaid Services (CMS) released proposed “voluntary” templates for physicians to document face-to-face encounters for home health patients. On Feb. 11, 2015, CMS...

Read more

Feature Articles

AHA RAC Reform Proposal Sparks Concern

Chuck Buck | 02.16.2015

AHA RAC Reform Proposal Sparks Concern

With the clock ticking down on the Recovery Auditor Contractors’ (RACs’) prohibition from conducting post-payment patient status reviews with dates of admission from Oct. 1, 2013 through March 31, 2015,...

Read more

IRF

Wishing You and Your Family Happy Holida…

Angela Phillips, PT - avatar Angela Phillips, PT | 12.22.2014

Wishing You and Your Family Happy Holidays!

To close out the year, we have provided you with a list of resources that provide the framework for inpatient rehabilitation facility (IRF) services. Each of the references has been...

Read more

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

Register Today!

Join Our Monitor Mondays Broadcast!

Register to Tune In Live