Frank Cohen, MPA | August 06, 2014

Another Band-Aid, Please: Treating the Symptoms, N

A few weeks ago, the Office of Medicare Hearings and Appeals (OMHA) announced what it described as a way to clear up the current federal backlog of appeals and move the process forward more efficiently. Of particular interest is the Statistical Sampling Pilot Program. Also of some interest is that the Centers for Medicare & Medicaid Services (CMS) has been conducting statistical audits for the past umpteen (I love that number) …

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Ronald Hirsch, MD | August 06, 2014

Senate Hearing Confused by Outdated Rules

I am opposed to the Eighteenth Amendment to the U.S. Constitution, which prohibits the manufacture, transportation, and sale of alcohol. I think that prohibition has done more harm than good and that alcohol should be legal to sell and consume in the United States. I therefore call on Congress to hold hearings on repealing the Eighteenth Amendment. Oh, wait, it was repealed in 1933. So I guess there is no reason …

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Timothy Powell, CPA | August 06, 2014

Medicare Advantage: Avoid Being at a Disadvantage

We all know what we went through during sequestration last year. As if the cuts were not enough, we had the accounting nightmare of what to do with the related deductibles and coinsurance differences. Adding insult to injury, your Medicare Advantage (MA) plans followed suit and reduced their payments. You have to scratch your head and wonder if that makes sense (in most cases, no, it doesn’t). You also may have …

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08.12.2014
Monitoring and Tracking: Are You Tracking Your Audits?
Monitoring and Tracking: Are You Tracking Your Audits?

EDITOR’S NOTE: A call-in by a listener to Monitor Mondays last Monday has prompted this special bulletin. So you know you are audited, you even know they are RAC audits, but what are you doing about it? How are you tracking what is audited, recouped, overturned, etc.? It is imperative that you are tracking every facet of every audit. When you receive...

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08.05.2014
Small Contract Gains for RACs
Small Contract Gains for RACs

The Centers for Medicare & Medicaid Services (CMS) signed contracts last week with the incumbent RAC contractors to provide limited Recovery Audit services through April 30, 2016, according to Monitor Mondays legislative analyst Emily Evans.  Evans, a partner with the Obsidian Research Group, said the contracts, valued at around $200,000, would be for limited RAC services.  “RACs will be permitted to handle...

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07.17.2014
Medicare RACs Are Only the Tip of the Iceberg: There Are Others Out There!
Medicare RACs Are Only the Tip of the Iceberg: There Are Others Out There!

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...

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07.17.2014
Evaluation and Management Services: Finding the Medical Necessity through Documentation Guidelines
Evaluation and Management Services: Finding the Medical Necessity through Documentation Guidelines

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...

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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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