Andrew B. Wachler, Esq. | September 18, 2014

CMS Offers “One-Size-Fits-All” Settlement for

In an attempt to mitigate the growing backlog of appeals and the attending strain on adjudicative resources, the Centers for Medicare & Medicaid Services (CMS) are offering an administrative agreement to certain providers. CMS will pay 68 percent of the net payable value of a denied eligible claim in exchange for a hospital’s acceptance of the administrative agreement as the full and final administrative and legal resolution of the claim.     CMS …

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Steven Greenspan, JD, LLM | September 18, 2014

MACs, ZPICs Given Discretion to Deny “Related”

On Feb. 5, 2014, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 505 and associated Change Request 8425. Transmittal 505 provided contractors with “the discretion to deny other related claims submitted before or after the claim in question.” It also allowed contractors to take action on claims that are not currently being reviewed and does not require the contractor to request additional documentation for the related claims prior …

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Frank Cohen, MPA | September 18, 2014

The Harder You Work, The More Dangerous it Becomes

Many years ago I attended a compliance conference, and one of the speakers was a former FBI agent who did work with the U.S. Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) on healthcare fraud issues. Back then there were a lot of fire-and-brimstone presentations about gun-wielding, door-breaking raids on medical practices, hospitals, and other healthcare institutions. From what I could tell, at least in …

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09.18.2014
APCs and the RACs
APCs and the RACs

Ambulatory Payment Classifications (APCs) were launched an Aug. 1, 2000 after numerous delays. APCs represent the main payment system that comprises the OPPS, or the Outpatient Prospective Payment System. The RACs (Recovery Audit Contractors) also were launched early in the 2000s, and their activities have grown significantly over the years. Today, the Centers for Medicare & Medicaid Services (CMS) refer to...

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09.04.2014
RAC Contracts in Holding Pattern Following Federal Court Ruling
RAC Contracts in Holding Pattern Following Federal Court Ruling

WASHINGTON, D.C. – The awarding of new Recovery Auditor (RAC) contracts likely will be delayed by at least a year following a ruling issued Tuesday by the U.S. Court of Federal Claims. The Court granted a request from CGI Federal to stay the awards of new RAC contracts in RAC regions 1, 2, and 4, the regions subject to litigation recently...

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09.04.2014
CERT Finds SNF Certification Deficiencies: Content of Certifications and Timing of Signatures Under Review
CERT Finds SNF Certification Deficiencies: Content of Certifications and Timing of Signatures Under Review

On August 19, 2015, the Centers for Medicare and Medicaid Services (CMS) fired a shot across the bow of the skilled nursing facility (SNF) industry when it released MLN Matters SE1428, “Comprehensive Error Rate Testing (CERT): Skilled Nursing Facility (SNF) Certifications and Recertifications.” In this publication, CMS reported, “The SNF inpatient improper payment rate increased from 4.8 percent during the...

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OIG

OIG Raps MACs in Report to Congress

Steven J. Meyerson, MD | 06.05.2014

OIG Raps MACs in Report to Congress

In its latest (Spring 2014) Semiannual Report to Congress of the Health and Human Services Office of the Inspector General (HHS OIG), Daniel R. Levinson, HHS Inspector General began by...

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Feature Articles

CMS 68% Solution Raises More Issues

Chuck Buck | 09.10.2014

CMS 68% Solution Raises More Issues

Andrew Wachler Tuesday’s national provider call conducted by the Centers for Medicare & Medicaid Services (CMS) to discuss its latest settlement offer raised a number of important questions that still have...

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IRF

FY 2015 Final Rule: Summary for Inpatien…

Angela Phillips, PT - avatar Angela Phillips, PT | 09.04.2014

FY 2015 Final Rule: Summary for Inpatient Rehabilitation Facilities

The Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule for the 2015 fiscal year was published on Aug. 6, 2014. The final published rule: Updates the federal prospective payment rates...

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