Ronald Hirsch, MD, FACP, CHCQM | May 18, 2016

CMS Suspends QIO Short-stay Audits

As reported on RACmonitor on April 18, the BFCC-QIO audits have not been without problems. The audits went back further than anticipated, the timelines for audit results and scheduling provider education are routinely being missed, and the timely filing deadline for hospitals to rebill denied claims to part B is fast approaching on many of the first-round denied claims. And now CMS has announced that the audits have been suspended. In a notice …

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Janelle Ali-Dinar, PhD | May 18, 2016

Do New Medicaid Rules Ease Shortage of Rural Primary Care Physicians?

With reports that within the next 20 years rural America could face a dangerous primary care shortage of up to 30,000 physicians, the issues of policy and innovation continue to weigh on the hearts and minds of those both providing and receiving care in rural communities.  Earlier this month, the Obama administration released a new set of rules addressing managed care plans under Medicaid and the Children’s Health Insurance Program, known …

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Gracielinda Prescott | May 18, 2016

Billing for Discarded Waste from a SDV: Assign Modifier JW to Retain Revenue

There has been a lot of information in the news recently about the amount that Medicare spends on high-cost drugs. If you have reviewed the Medicare Drug Spending Dashboard, you may have identified many of the drugs and biologicals as being packaged as a single-use or single-dose vial (SDV). On April 29, the Centers for Medicare & Medicaid Services (CMS) issued an update mandating the use of modifier JW when billing …

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05.11.2016
Short-Stay Inpatient Rate is Zero? Time for Documentation Improvement
Short-Stay Inpatient Rate is Zero? Time for Documentation Improvement

The revised exceptions policy found in the 2016 Outpatient Prospective Payment System (OPPS) Final Rule (CMS-1633-F), which became effective Jan. 1, 2016, may change how providers determine patient status. The policy acknowledges specific situations in which inpatient status is appropriate even when the stay is less than two midnights, if supported by proper documentation. As a result, hospitals may need...

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05.11.2016
Section 603 Discussion in Anticipation of Upcoming CMS Rule
Section 603 Discussion in Anticipation of Upcoming CMS Rule

As you may be aware, the Bipartisan Budget Act of 2015 was enacted on Nov. 2, 2015, to be effective on Jan. 1, 2017. There was no real warning that this regulatory change would be impacting the hospital industry aside from the longstanding concerns of MedPAC, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG),...

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05.11.2016
Don’t Wait to Facilitate Your Part A and Part B Medicare Appeals
Don’t Wait to Facilitate Your Part A and Part B Medicare Appeals

Medicare Part A and B providers and suppliers should review their pending Medicare claims and determine whether the claims are eligible for resolution through the Office of Medicare Hearings and Appeals (OMHA) Settlement Conference Facilitation Pilot Program (SCF).  Through SCF, Medicare Part A and B providers are invited to voluntarily resolve eligible claims pending at the administrative law judge (ALJ) level...

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05.11.2016
The MOON, Self-Administered Drugs, and Copayments
The MOON, Self-Administered Drugs, and Copayments

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act requiring written notification to Medicare patients of observation services became law on Aug. 6, 2015, and implementation is required by Aug. 6, 2016. While many states had already beaten the Centers for Medicare & Medicaid Services (CMS) to the punch by enacting their own laws, as described in...

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OIG

OIG Work Plan: Fair Warning

Chuck Buck | 11.04.2015

OIG Work Plan: Fair Warning

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) 2016 Work Plan comes with a warning: the OIG continues to be relentless in detecting and...

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Feature Articles

Healthcare Radio Documentary to Pioneer …

Mark Spivey | 05.18.2016

Healthcare Radio Documentary to Pioneer Exposing of Investigatory Audits

Chuck Buck What is being billed as the healthcare industry’s first Internet radio documentary to expose the inner workings of investigatory audits is scheduled to air live on Thursday, June 2...

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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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