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RACs and Readmissions: Take Action to Determine the Causes

With one RAC - HealthDataInsights, for Region D - having set its sights on readmissions as a possible target - could the other RACs have a collection strategy in the works?   Studies estimate that as many as 20 percent of hospitalizations are readmissions that occur within 30 days of discharge, and 34 percent are readmissions Read more

RACs Deny $2.47 Million in Medicare Claims in First Quarter

By: Frank Sheeder, Esq. and Lindsey F. Bartula, Esq.   There are some recent reports that quantify RAC activity for the first part of 2010. Results from the American Hospital Association's (AHA's) April 2010 RACTrac Survey indicate that for 653 responding hospitals, RACs denied a total of $2.47 million in Medicare claims during the first quarter Read more

For Want of a Procedure Note, A Payment Was Lost – A Fable

By: Linda Fotheringill, Esq. and Cynthia M. Lipsitz, MD, MPH   There are many of us physicians and other healthcare professionals who regularly write notes in medical records, but are not yet fully aware of the relationship between our documentation practices, medical coding and reimbursement. The complexities of coding and DRGs are tiresome to busy physicians, so Read more

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This Week's Top Stories are sponsored by: Panacea Healthcare Solutions, LLC.

29

Jul

2010

The Data Manager: Reporting Coding Quality Measures for Improper Payment, Part 2 PDF Print E-mail
Written by Carol Spencer, BA, RHIA, CCS, CHDA   

By: Carol Spencer, RHIA, CCS, CHDA and Jill Sell-Kruse, RHIA, CCS

 

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ED. NOTE: This is the second of three series of articles designed to compare and contrast the "coding-state" coding manager's role;s and responsibilities of today in contrast to the "data-state" data manager's roles and responsibilities of tomorrow. The first article discussed integration of controls and safeguards. This article compares and contrasts coding quality measures for improper payment.

 

When evaluating coding, it is interesting that coding managers generally access quality based on accuracy rates whereas regulatory agencies, or those contracted by the Centers for Medicare & Medicaid Services (CMS) such as Recovery Audit Contractors (RACs), evaluate coding quality based on dollars or payment error rates.

Read more...
 

26

Jul

2010

The Data Manager: Controls and Safeguards for Revenue and Data Integrity, Part 1 PDF Print E-mail
Written by Carol Spencer, BA, RHIA, CCS, CHDA   

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ED. NOTE:

This is the first of a three-part series designed to compare and contrast the current and future states of coding and the coding manager's roles and responsibilities. The article below summarizes the movement from a retrospective review process to a prebill, concurrent review process that includes medical necessity, clinical documentation improvement (CDI), and coding.

 

Today's coding "world" tends to be focused on quality and productivity, based on audits of individual records and the number of records coded. The future promises a move from the traditional coding manager to an "integrated-state" data manager, with the goal being to reduce financial risk and increase data integrity.

Read more...
 

23

Jul

2010

CGI Follows Connolly, Adds Review of Inpatient Admission Orders Plus 88 More DRG Validation Issues PDF Print E-mail
Written by Ernie De Los Santos   

ernieFollowing the lead of Connolly Healthcare, CGI, the RAC for CMS Region B, has posted an approved issue to review Inpatient Admission Orders.

 

CGI is the second RAC to post the issue. The wording is identical to Connolly’s posting of the same issue and is listed as follows:

Read more...
 

22

Jul

2010

President Signs Improper Payment Elimination and Recovery Act PDF Print E-mail
Written by Chuck Buck   

cbuck120dsSaying that his goal is to reduce improper payments by $50 billion between now and 2012, President Barack Obama signed into law today the Improper Payment Elimination and Recovery Act, a bill he noted that was unanimously passed by both houses of Congress.

 

In signing the bill, the President said overpayments from scam artists amounted to $110 billion representing more than the combined budgets of the Department of Education and the Small Business Administration. The President also announced the existence of a "no pay" list of entities that are ineligible to receive payments.

Read more...
 

Feature Stories

Stepped-up Government Oversight Reported

Cheryl E. Servais, MPH, RHIA | Thursday, 6 May 2010

The Health Care Compliance Association held its annual conference April 18 – 21 in Dallas.  The approximately 2,000 people who attended the conference were provided access to 35 programs that focused on various aspects of the stepped-up oversight activities on Medicare and Medicaid reimbursement being conducted by federal and state...

Read More...

New Levels of Enforcement Mean Significant Risk for Providers

Bret Bissey, MBA, FACHE, CHC | Thursday, 6 May 2010

If you were one of the more than 2,000 people in attendance at the Health Care Compliance Association’s annual institute in Dallas this April, you probably were impressed, as I was, with the increased focus and energy that our government and enforcement colleagues brought to the meeting. I was left...

Read More...

More in: Feature Articles

News Analysis

Healthcare Reform, Your Compliance Program and RAC

Bret Bissey, MBA, FACHE, CHC | Wednesday, 7 July 2010

By now you probably are familiar with recently enacted provisions of the new Patient Affordable Care Act (PACA), which includes several changes to the federal False Claims Act and Anti-Kickback Statute, plus alterations of other requirements associated with timely repayments of overpayments. All of this probably will impact every compliance...

Read More...

OIG Releases Report on IRF: CMS Response Indicates Potential RAC Involvement

Nancy J. Beckley, MB, MBA, CHC | TUSEDAY, 29 June 2010

This past week the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) posted a report of a nationwide review of inpatient rehabilitation facilities' transmission of patient assessment instruments for 2006 and 2007.   The CMS response to the report indicates a likely new...

Read More...

More in: News Analysis

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