This week was quite the week for the Medicare Advantage (MA) plans. A blog post on Health Affairs criticized traditional Medicare in its entirety, noting that each of the parts of Medicare has its own “idiosyncratic” cost-sharing structures and the potential for unlimited copayment; the same post touted the wonderful extra benefits that Medicare Advantage plans provide such as dental and vision care, hearing aids, and even health club memberships. Next …Read more
Is it possible that the until-now-unheard-of notion of simplicity has been introduced within the healthcare industry? If so, something accompanying it might be the movement of DPC, or direct primary care, through which unlimited primary care drives down overall costs while improving patient outcomes and experiences. Hailed by Time as “one of the most intriguing experiments in the medical industry,” the notion is based on an analysis conducted by Qliance Medical …Read more
Those who are involved in charge capture and claim submission processes are probably familiar with the National Correct Coding Initiative (NCCI) and the procedure-to-procedure edits and medically unlikely edits that apply to the CPT® coding hierarchy for drug administration. Many, however, (including many hospital pharmacists) are unaware of the medically unlikely edits (MUEs) that the Centers for Medicare & Medicaid Services (CMS) have begun applying to claims for drugs. The MUEs …Read more
EDITOR’S NOTE: During 2016, RACmonitor will be ramping up its coverage of the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG). Four areas associated with recent activities of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) are proving to be of great interest for providers: the civil monetary penalties...Read more
The Centers for Medicare & Medicaid Services (CMS) recently released a request for information that will be used to collect feedback to design an expanded recovery audit contract program for Medicare Advantage plans. The soon-to-be-initiated audit program expansion is meant to give CMS the ability to monitor insurers that may try to sneak in higher payments. The expansion focuses on...Read more
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audit letters dropped silently, one by one across the eight-hospital network, as if delivered by specters in the night. Addressed to each facility’s “compliance officer” by the regional OIG office, the letters targeted potential errors suspected after the furnishing of implantable cardiac medical devices for both...Read more
Now you and your facility can benefit from receiving crucially important tips, techniques and strategies before appealing your case to the Office of Medicare Hearings and Appeals and you find yourself standing face-to-face before an Administrative Law Judge.
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