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 …Read more
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 …Read more
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 …Read more
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...Read more
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),...Read more
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...Read more
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...Read more
Predatory contractor auditors use dirty tricks to extrapolate huge sums of money that they contend must be paid back. Now you'll learn how to see behind their devious methods and protect your facility's revenue and reputation through this important and accessible webcast — a must attend for anyone in your facility dealing with claim denials.
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