On Friday evening the Centers for Medicare & Medicaid Services (CMS) released its long-awaited request for proposals for the Medicare Recovery Auditors (RAs). As this program has been the subject of much political, regulatory, and judicial meddling, there are no surprises. The basic contours of the program are the following: There will be five RAC regions instead of the current four. Four of the five regions will be dedicated to audits of …Read more
The Medicare home health face-to-face brief narrative requirement has been a point of contention for the home health industry since its implementation in 2011. After implementation of the requirement, home health agencies across the country experienced a deluge of denials from Medicare contractors on the basis that the face-to-face brief narratives were “insufficient.” The denials applied inconsistent standards, and as a result, the National Association of Home Care & Hospice, …Read more
The current reimbursement landscape has been nothing short of a daunting challenge for hospitals. Intense scrutiny by Medicare Recovery Auditors (RACs) and Medicare Administrative Contractors (MACs) on admission status assignment (i.e., inpatient versus outpatient/observation) has prompted providers to invest significant time and resources strengthening their utilization review (UR) processes. The ripple effect that admission status determination causes introduces a whole new set of questions to be answered: What are the financial …Read more
The 2016 Outpatient Prospective Payment System (OPPS) Final Rule finally has been released, and the Centers for Medicare & Medicaid Services (CMS) has adopted the proposed change to the two-midnight rule to allow for physician judgment. While this may have muddied the waters a bit for determinations for patients with traditional fee-for-service Medicare, that confusion and frustration pales in comparison to...Read more
The healthcare industry is finally catching up to other industries in its deployment and use of advanced analytics tools. Payers, providers, and auditors are now able to quickly collect and analyze vast amounts of claims data. As they do so, previously hidden coding errors, documentation gaps, and misappropriated Medicare funds are being uncovered for all to see. This has resulted, not...Read more
Starting Jan. 1, 2016, hospitals will need to alter the way in which they bill for both professional and facility component claims for off-campus, hospital-based (or, more accurately, provider-based) clinics. The Centers for Medicare & Medicaid Services (CMS) has decided to start collecting data relative to these clinics, and presumably, other off-campus provider-based operations as well. CMS is collecting this data...Read more
| RACmonitor.com, a division of Panacea Healthcare Solutions, Inc.
287 East 6th Street | Suite 400 | St. Paul, MN | 55101 • TOLL FREE: 800.252.1578