During the recent Office of Medicare Hearings and Appeals (OMHA) Medicare Appellant Forum held on October 29, 2014, in Washington, D.C., Chief Administrative Law Judge (ALJ) Nancy Griswold indicated that the current OMHA initiatives were moving ahead, but slowly. Judge Griswold also advised the group of 80 in-person attendees, and roughly 500 webinar attendees, that OMHA was committed to reducing the backlog and would shortly be putting out a call …Read more
HHS OIG Chief of Staff Christi Grimm WASHINGTON, D.C. – The Medicare portion of the newly unveiled 2015 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan, the launch of open enrollment in Patient Protection and Affordable Care Act marketplaces, and oversight of an expanding Medicaid program were three topics on the table when HHS OIG Chief of Staff Christi Grimm spoke on Monitor Mondays …Read more
While hospitals have been busy weighing the pros and cons of the Centers for Medicare and Medicaid Services (CMS) appeals backlog settlement, preparing their spreadsheets and figuring out if their 68 percent will be 52 percent or 78 percent, the never-ending fun of the two-midnight rule is continuing. Within the last several weeks, the Medicare Administrative Contractors (MACs) have started issuing record requests and the second round of probe audits have …Read more
As we’ve noted in prior articles, while inpatient rehabilitation facilities (IRFs) have had some relief from Recovery Auditors (RACs), inpatient rehabilitation claims are still under scrutiny from a wide range of auditors, including Medicare Administrative Contractors (MACs), Comprehensive Error Rate Testing (CERT) contractors, Zone Program Integrity Contractors (ZPICs), and Supplemental Medical Review Contractors (SMRCs). And what’s even more disconcerting is...Read more
In general, physician-owned distributorships (PODs) are companies with physician owners or investors that sell implantable medical devices to hospitals and healthcare facilities. The revenue generated by PODs typically derives from orders by the PODs’ physician owners, who also use the implantable medical devices for procedures on their own patients at hospitals or healthcare facilities. Although there are a variety of ways...Read more
As we mark the first anniversary of the two-midnight rule, more private payers are opting to implement it – or some principle that is at least based on it. I received an email from one hospital asking: “One of our Medicare Advantage plans said that they plan to ‘use the two-midnight rule’ and (that) they will also continue to use ‘evidence-based...Read more
Hospitals like yours have been struggling against a variety of challenges including admission penalties, quality reductions, and audit recoupments. With thin margins, many can't afford to provide free services when they are entitled to payment.
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