A couple of years ago, the Centers for Medicare & Medicaid Services (CMS), in a stated effort to be more transparent, released a database containing most of the procedures billed to Medicare by physicians for the 2012 calendar year. The next year, the agency released the same data for 2013, and again, earlier this year, it released the data for 2014. In each case, the data was two years old by …Read more
By now, most hospitals have received chart requests for the short-stay inpatient admission audits being conducted by the Beneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs). To this end, I previously reported on the KEPRO educational webinars on RACMonitor.com. Today I have to tell you about the recent presentation by Livanta on these audits and how to apply the two-midnight rule. I should preface this by noting that the presentation was …Read more
On Friday, Oct. 14, CMS issued the final Merit-Based Incentive Payment System (MIPS) rule under the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA. MIPS will start with a 4-percent impact on Part B payment to eligible clinicians, with that shift ultimately climbing to 9 percent. Initially, eligible clinicians are classified as physicians, osteopaths, dentists, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. …Read more
Congress has issued a letter to the Centers for Medicare & Medicaid Services (CMS) indicating that the agency should provide more flexibility in the implementation of the Section 603 provisions of the Bipartisan Budget Act of 2015. CMS had proposed very restrictive rules in the July 14, 2016 Federal Register as a part of the Outpatient Prospective Payment System (OPPS) updating...Read more
The situation at the Office of Medicare Hearings and Appeals (OMHA) continues to deteriorate. The appeals backlog continues to explode, and different options are being considered to solve the problem. In part I of this series, we will examine the statistics behind the backlog. In Part II, we will examine the proposal to add a new role for attorney adjudicators (AAs),...Read more
One of the more complicated administrative matters many hospitals, medical schools, and large physician groups deal with is how to implement and manage a conflict-of-interest disclosure program in their organizations. In healthcare, a potential conflict of interest can be broadly defined as any situation in which a decision-maker or one or more of their immediate family members has a financial...Read more
This week, the American Hospital Association (AHA) will get the chance to tell Washington, D.C. District Judge James Boasberg what it thinks must be done to fix the tremendous backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA). There are about 920,000 appeals on backlog at OMHA. That number is expected to grow to over a million by...Read more
By attending this timely webcast, you will be made aware of the potential impact that the JW modifier can have on your organization and also know how critical documentation and medical necessity are to a successful transition.
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