Chuck Buck | July 17, 2014

Mixed Reviews Greet Settlement Conference Facilita

WASHINGTON, D.C. – The announcement of the new pilot program from the Office of Medicare Hearings and Appeals (OMHA) intended to help mitigate the highly publicized backlog of appeals at the Administrative Law Judge (ALJ) level came at a propitious time last week, against a backdrop of two pertinent hearings on Capitol Hill. OMHA’s Settlement Conference Facilitation Pilot (SCF) was quoted in a staff report from the U.S. Senate’s Special Committee …

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Shannon DeConda | July 17, 2014

Evaluation and Management Services: Finding the Me

Earlier this month RACmonitor informed us of the new U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) release encouraging the Centers for Medicare & Medicaid Services (CMS) to place more scrutiny on evaluation and management (E&M) services, with the suggestion based on the staggering statistics surrounding improper payments for these services. E&M services often are selected incorrectly due to the level assigned being based on documentation …

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Ralph Wuebker, MD, MBA | July 17, 2014

Medicare RACs Are Only the Tip of the Iceberg: The

In a June 19 article I wrote for RACmonitor titled “Four Myths about IPPS Best Practices – And Why You Shouldn’t Believe Them,” I noted that one of the most common misconceptions in our industry is that there will be no more audits until April 1, 2015 at the earliest – or, as some are even thinking, that audits are gone for good. This certainly is not the case, as Medicare …

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07.17.2014
Medicaid Dental Audit Akin to Tooth Ache
Medicaid Dental Audit Akin to Tooth Ache

Dr. MeeskeCredit: ADA The subject of Medicaid RAC audits found its way into the conversation at the recent roundtable meeting entitled “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations,” hosted by the U. S. Senate Special Committee on Aging. Jessica Meeske, DDS, a dentist who serves Medicaid patients in rural Nebraska, related the story of the first Medicaid...

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07.03.2014
MAC Two-Midnight Webinar Muddies the Waters
MAC Two-Midnight Webinar Muddies the Waters

The probe-and-educate phase is in full swing, with hospitals receiving results of their probe audits and Medicare Administrative Contractors (MACs) conducting extensive education, performing both one-on-one sessions with hospitals and conducting general education via webinars and teleconferences. The one-on-one sessions vary among MACs; in some instances the MAC representative presents general education about the two-midnight rule in a lecture format, some...

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07.03.2014
A Relevant but Underreported Issue Health System Leaders Face When Dealing with RAC Audits
A Relevant but Underreported Issue Health System Leaders Face When Dealing with RAC Audits

As health system leaders continue to react to continuously updated regulations, many have been expressing their concern for the ongoing administrative burden that exists because of expanded Medicare oversight and its Recovery Auditor (RAC) audit program. Their focus, of course, remains on compliance, and ensuring that providers respond to audit requests in a timely and accurate manner. However, until recently, as...

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07.03.2014
Hospital Outpatient ASC Payment Rates – A RAC Audit Issue in the Making
Hospital Outpatient ASC Payment Rates – A RAC Audit Issue in the Making

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) has issued an April 2014 report recommending a significant payment change. The report boasts a rather impressive title: “Medicare and Beneficiaries Could Save Billions If CMS Reduces Hospital Outpatient Department Payment Rates for Ambulatory Surgical Center-Approved Procedures to Ambulatory Surgical Center Payment Rates” The basic idea is that,...

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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

Site-Neutral Payments: A June 2014 MedPA…

Angela Phillips, PT - avatar Angela Phillips, PT | 07.03.2014

Site-Neutral Payments: A June 2014 MedPAC Report

The June 2014 MedPAC report to Congress included information on the commission’s review and recommendations for site-neutral payment when rehabilitation of certain conditions occurs in different post-acute-care facilities. The report...

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