David M. Glaser, Esq. | April 17, 2014

Risk of Trusting Data

Last week the Centers for Medicare & Medicaid Services (CMS) released data on the reimbursement Medicare pays to individual physicians. The data provides a great illustration of one of the challenges of healthcare: it is risky to trust data, and it is risky to dismiss it. There is another risk of data as well: sometimes its mere existence can change behavior. This may seem counterintuitive, but sometimes data can actually increase …

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Ronald Hirsch, MD | April 17, 2014

Place of Service Under Scrutiny; Physician Payment

As many of you know, several weeks ago the Centers for Medicaid & Medicare Services (CMS) issued Transmittal 505, which would have allowed auditors to deny what they labeled “related claims” without any further record review. There was rejoicing, as this would allow the denial of physician claims when an admission is denied, meaning doctors would finally have some skin in the game. The transmittal gave two examples: when denial of a …

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Steven J. Meyerson, MD | April 17, 2014

Beware the “One Plus One” Inpatient Stay

Ever since the two-midnight rule became effective on October 1, 2013, industry discussion about audits has centered on one-midnight stays because these are the most vulnerable to admission status error and thus to the risk of denial or recoupment at the hands of a Medicare contractor. Admission documentation for one-midnight stays will be under intense scrutiny: Did the physician sufficiently document both the need for hospital care and the basis …

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04.17.2014
AHA Lawsuit: Too Little, Too Late?
AHA Lawsuit: Too Little, Too Late?

At a time when moviegoers are flocking to see the biblical epic “Noah,” in which the titular protagonist goes about collecting the world’s species by twos, the American Hospital Association (AHA) on Tuesday filed a pair of lawsuits against the U.S. Department of Health and Human Services (HHS), challenging the contentious “two-midnight” rule for determining inpatient status. Meanwhile, in a...

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04.03.2014
Hospices, RACs, ZPICs, UPICs, and the Whole Alphabet Soup
Hospices, RACs, ZPICs, UPICs, and the Whole Alphabet Soup

If you are running a hospice and are not under audit by one of the many governmental bodies out there, you are either very lucky or you are fibbing. The pattern has expanded to include Medicaid through a variety of subcontractors here in Florida. Many of the hospices across the country are scared even to reach out to their trade groups...

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04.03.2014
Drawing Conclusions from the Record, Draws Contention
Drawing Conclusions from the Record, Draws Contention

Can coders infer or deduce from the medical record? It’s elementary, my dear physician. During a recent Monitor Monday broadcast, I postulated that coders could draw some conclusions from medical records. In particular, I asserted that if the records contain facts that demonstrate that a patient has a particular diagnosis, but the records don’t include the actual label, I believed the...

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04.03.2014
The RACs, Hospitals, and Physician-Associated Services
The RACs, Hospitals, and Physician-Associated Services

On Feb. 5, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 505,1 and then, on March 19, it rescinded the transmittal.2 At issue was the concept of “related services” and the ability of government auditors to recoup payments from associated providers when there is a denial for only one of the providers. For instance, if a surgical procedure...

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OIG

OIG Releases “Robust” Work Plan to Tackl…

Janis Oppelt | 02.06.2014

OIG Releases “Robust” Work Plan to Tackle New Healthcare Market Place

Millions of people who were previously uninsured will gain health insurance coverage in 2014, thanks to the Patient Protection and Affordable Care Act (ACA) of 2010. The ACA, which enacted...

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Feature Articles

Providers Weigh in on ALJ Appeal Delay

Chuck Buck | 01.23.2014

Providers Weigh in on ALJ Appeal Delay

Providers were quick to react to the decision by the Office of Medicare Hearings and Appeals (OMHA) to suspend new hearing requests for two years. In an OMHA memo obtained by...

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IRF

Medicare Interrupted Stays Still Trouble…

Angela Phillips, PT - avatar Angela Phillips, PT | 04.17.2014

Medicare Interrupted Stays Still Troublesome for IRFs

Interrupted stays, which have been present since the outset of IRF-PPS, continue to be problematic for inpatient rehabilitation facilities (IRFs). Medicare patients who leave an IRF to receive services at...

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