Ronald Hirsch, MD, FACP, CHCQM | February 03, 2016

Medicare Advantage: Criticism Continues

This week was quite the week for the Medicare Advantage (MA) plans. A blog post on Health Affairs criticized traditional Medicare in its entirety, noting that each of the parts of Medicare has its own “idiosyncratic” cost-sharing structures and the potential for unlimited copayment; the same post touted the wonderful extra benefits that Medicare Advantage plans provide such as dental and vision care, hearing aids, and even health club memberships. Next …

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Gracielinda Prescott | February 03, 2016

Direct Primary Care: A Consideration for Rural Health

Is it possible that the until-now-unheard-of notion of simplicity has been introduced within the healthcare industry? If so, something accompanying it might be the movement of DPC, or direct primary care, through which unlimited primary care drives down overall costs while improving patient outcomes and experiences. Hailed by Time as “one of the most intriguing experiments in the medical industry,” the notion is based on an analysis conducted by Qliance Medical …

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Gracielinda Prescott | February 03, 2016

CMS Applying MUEs to Drug Claims

Those who are involved in charge capture and claim submission processes are probably familiar with the National Correct Coding Initiative (NCCI) and the procedure-to-procedure edits and medically unlikely edits that apply to the CPT® coding hierarchy for drug administration. Many, however, (including many hospital pharmacists) are unaware of the medically unlikely edits (MUEs) that the Centers for Medicare & Medicaid Services (CMS) have begun applying to claims for drugs. The MUEs …

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01.27.2016
Civil Monetary Penalties Head List of OIG Enforcement Actions
Civil Monetary Penalties Head List of OIG Enforcement Actions

EDITOR’S NOTE: During 2016, RACmonitor will be ramping up its coverage of the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG).  Four areas associated with recent activities of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) are proving to be of great interest for providers: the civil monetary penalties...

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01.27.2016
Expanding the RAC Program to Medicare Advantage Plans
Expanding the RAC Program to Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) recently released a request for information that will be used to collect feedback to design an expanded recovery audit contract program for Medicare Advantage plans. The soon-to-be-initiated audit program expansion is meant to give CMS the ability to monitor insurers that may try to sneak in higher payments. The expansion focuses on...

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01.27.2016
Five Potential OIG Targets for Implantable Medical Device Credits
Five Potential OIG Targets for Implantable Medical Device Credits

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audit letters dropped silently, one by one across the eight-hospital network, as if delivered by specters in the night. Addressed to each facility’s “compliance officer” by the regional OIG office, the letters targeted potential errors suspected after the furnishing of implantable cardiac medical devices for both...

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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

RACmonitor Expands Editorial Board

Mark Spivey | 02.03.2016

RACmonitor Expands Editorial Board

A former official with the Centers for Medicare & Medicaid Services (CMS) is among four new members joining the RACmonitor editorial board.  The changes were announced this week by Chuck Buck,...

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IRF

IRFs’ 2016 Focus: Establish Your Own “Wo…

Angela Phillips, PT - avatar Angela Phillips, PT | 01.20.2016

IRFs’ 2016 Focus: Establish Your Own “Work Plan”

Inpatient rehabilitation facilities (IRFs) will continue to face a plethora of audits from a variety of regulatory agencies during 2016. Each of these agencies has a work plan or scope...

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