Janelle Ali-Dinar, PhD | February 15, 2017

The MACRA Link to Population Health

The Medicare Access & CHIP Reauthorization Act (MACRA) became effective Jan. 1, 2017, making it imperative that rural providers and hospitals leverage some practical application so the promise of tying a greater percentage of payment to performance can be sought and achieved.    No matter the noble the intent, this nonetheless has several rural providers and critical access hospitals (CAHs) concerned. The Merit-Based Incentive Payment System (MIPS) Quality Payment Program (QPP) …

Read more
David M. Glaser, Esq. | February 15, 2017

The Rules Don’t Apply: Private Payers

A client called me this week after receiving the results of an audit by a private insurer. While I have done Medicare audits for clients in nearly every state, audits by private insurers are rare. They happen, but they are atypical. If you are used to dealing with Medicare audits, it is important to understand that private pay audits, while similar, are not identical. The first major difference is that the …

Read more
Gracielinda Prescott | February 15, 2017

Benchmark Survey Addresses Most Challenging Aspects of ROI

HCPro’s HIM Briefings published its first release of information (ROI) benchmarking survey of 2017 last month. The survey, conducted in December 2016, explored health information management (HIM) and ROI professionals’ challenges, triumphs, and insights, covering U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) patient access guidance, hybridization of medical records, ROI staffing, billing and requests, and patient authorizations and logging. Of special interest was the coverage …

Read more
02.08.2017
Spotlight on Medicaid Block Grants Amid Looming Changes to Healthcare
Spotlight on Medicaid Block Grants Amid Looming Changes to Healthcare

Now that the new presidential administration has taken office, we can expect some modifications to the Medicaid program as an entitlement arrangement. Currently, everyone who is eligible based on income compared to the federal poverty level is awarded a coverage spot for healthcare services. Will the Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA) continue in its...

Read more
02.08.2017
DME Suppliers as the Whipping Boy of the Medicare Industry
DME Suppliers as the Whipping Boy of the Medicare Industry

Durable medical equipment (DME) suppliers have a target on their backs. It is likely that they are subjected to the most frequent audits of any type of healthcare provider. The CERT (Comprehensive Error Rate Testing) audits seem to be the most frequent. Although DME represents a small percentage of expenditures on healthcare, in 2015 (the last year for which data is...

Read more
02.08.2017
Report: Rural Health a Target for Harm by Trump Travel Ban
Report: Rural Health a Target for Harm by Trump Travel Ban

EDITOR’S NOTE: A 9th Circuit Court of Appeals has yet to issue a decision on the federal government’s request to lift a district court judge’s order that blocked enforcement of President Trump’s travel ban directive. Concerns over constitutionality aside, the recently enacted international travel ban put in place via executive order by President Donald J. Trump could threaten the viability of...

Read more
02.08.2017
What Are We to Do About Condition Code 44?
What Are We to Do About Condition Code 44?

Sept. 10, 2004 was a day of mixed blessings in the case management world. On that day, the Centers for Medicare & Medicaid Services (CMS) released MLN Matters SE 0622, titled Clarification of Medicare Payment Policy When Inpatient Admission is Determined to be Not Medically Necessary, Including the Use of Condition Code 44: Inpatient Admission changed to Outpatient. With this, finally,...

Read more

OIG

OIG 2017 Work Plan: Inpatient Rehabilita…

Angela Phillips, PT | 12.14.2016

OIG 2017 Work Plan: Inpatient Rehabilitation Facilities Still on the Radar

    The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released its 2017 work plan, which includes a list of reports it plans to publish...

Read more

Feature Articles

Why You Should Use the New Request for H…

Bob Soltis | 02.15.2017

Why You Should Use the New Request for Hearing Form

The advent of revised regulations for administrative law judge (ALJ) hearings of Medicare appeals includes a new request for ALJ hearing or review of dismissal form. Because the new form —...

Read more

IRF

OIG 2017 Work Plan: Inpatient Rehabilita…

Angela Phillips, PT - avatar Angela Phillips, PT | 12.14.2016

OIG 2017 Work Plan: Inpatient Rehabilitation Facilities Still on the Radar

    The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released its 2017 work plan, which includes a list of reports it plans to publish...

Read more

Register for your FREE subscription to RACmonitor eNews, delivered right to your inbox.

Register Today!