Gracielinda Prescott | August 24, 2016

Developing: Clinical Validation versus DRG Validation

Going back to the late 2000s, when I worked as a contract coder full-time, we were constantly being told both to code and not to code the same diagnoses under the same circumstances and by the same physicians.  Depending on what day it was, and who was the last person to talk to our in-house auditor, we might be told we should have reported a diagnosis because it was present. Then …

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Ronald Hirsch, MD, FACP, CHCQM | August 24, 2016

Billing for Services After Death

In 2006, David Brennan, then-president of international pharmaceutical giant AstraZeneca, famously stated that "Americans have a funny approach to this (the option of forgoing chemotherapy at the end of life). We think death is optional." While death is not optional, the administrative aspects of dying can be more complicated than many of us realize. In my practice, I once cared for a rather ill hospitalized patient. The patient improved and was discharged …

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Timothy Powell, CPA | August 24, 2016

Hacking: The Biggest Compliance Issue of Our Time

A Bon Secours Health System hospital recently reported a data breach affecting 655,000 patients. Their patient data was left online and open to the public by a consulting firm.  You apparently do not have to “hack” anything these days. Lately we have seen the email servers of political parties and politicians accessed and embarrassing emails released. What if, instead of emails, hackers wanted patient and compliance information from your company to …

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08.17.2016
Federal Settlement Could Lead to Faster ALJ Decisions for Beneficiaries
Federal Settlement Could Lead to Faster ALJ Decisions for Beneficiaries

The Center for Medicare Advocacy (CMA) is touting the anticipated benefits of a recent ruling by a federal judge in Connecticut that could lead to faster Medicare appeal hearings and decisions involving administrative law judges (ALJs) nationwide. “Although required by law to issue decisions within 90 days of receiving a request for … (ALJ) review, Medicare’s Office of Hearings and...

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08.17.2016
Another MOON Shot: What the Form Means for Hospitals
Another MOON Shot: What the Form Means for Hospitals

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act’s requirements were originally set to take effect on Aug. 6, 2016; however, the Centers for Medicare & Medicaid Services (CMS) is providing 30 more days for comment on their form (not on the process) and then 90 days to implement it. There are issues with both the form and...

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08.17.2016
Do New Guidelines Pose Potential Audit Risk?
Do New Guidelines Pose Potential Audit Risk?

The 2017 Inpatient Prospective Payment System (IPPS) final rule has codified in very direct terms a policy ruling that coders may not choose to assign (or not assign) codes based on clinical criteria. The physician’s diagnosis is king, even if the clinical indicators may fail to support it. The initial reaction from many coders was that this finally vindicates them in...

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08.17.2016
Keeping Score: A CMS Ranking Program that Just May Work!
Keeping Score: A CMS Ranking Program that Just May Work!

Those who have read my past articles already know that I am not a fan of physician ranking or scoring programs. Checkbook USA and ProPublica each publish a scorecard that supposedly ranks the quality of care provided by physicians, and while they put a lot of time and solid research into their metrics, they lack one very major component: a...

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OIG

Looking Back: OIG Fraud Alert on Physici…

Gracielinda Prescott | 08.03.2016

Looking Back: OIG Fraud Alert on Physician Compensation Arrangements

This June marked a year since the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its fraud alert about physician compensation arrangements. The purpose...

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Feature Articles

Reopening the 68-Percent Settlement: A P…

Chuck Buck | 08.24.2016

Reopening the 68-Percent Settlement: A Provider Speaks Out

Michelle McAdoo Michelle McAdoo advocates for second chances – especially when it comes to the the Centers for Medicare & Medicaid Services’ (CMS’s) once-lauded 68-percent settlement, an option the agency no...

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IRF

Nordian Posts Results of Recent Oregon P…

Angela Phillips, PT - avatar Angela Phillips, PT | 05.04.2016

Nordian Posts Results of Recent Oregon Probe Audit:  Once Again, No Surprises for IRFs in the Results

Last month, we discussed Noridian’s findings from the IRF Probe Audit for Arizona conducted from December 21, 2015, through March 3, 2016. At that time, we agreed to provide the...

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