John Zelem, MD | August 21, 2014

The Rocky Road to Proper Physician Documentation

Physician documentation has evolved over the last 10 years to the point that some would say it has deteriorated in the quality of its purpose. There are multiple factors driving this trend, some with more prominence than others. In 1971, revolutionary thinker Dr. Lawrence Weed introduced the concept of the SOAP note, an acronym for subjective objective assessment plan. Known as the “father of the problem-oriented medical record,” Dr. Weed recognized that …

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Sandra Routhier, RHIA, CCS | August 21, 2014

MS-DRG Validation Still a Priority

Hospital inpatient reimbursement continues to be at risk whether or not third-party payers are actively auditing for recoupment. In addition to Medicare fee-for-service, many payers reimburse inpatient stays based on MS-DRGs or some form of DRG system. Inpatient hospitalization is a costly level of care, and hospitals need to assure that the correct DRGs are being assigned and billed to receive proper reimbursement for the conditions treated and services provided.  While Recovery …

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David M. Glaser, Esq. | August 20, 2014

Private Insurance Audits: Rarely Sighted But Incre

Private insurance audits used to be rare, but over the last few years, they seem to be on the increase. The initial contact from a private insurer may ask you to submit written records or it may include a request for a site visit. The first thing you want to do is review any contract you have with the payer and determine whether it allows the audit. You will also want …

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08.05.2014
Small Contract Gains for RACs
Small Contract Gains for RACs

The Centers for Medicare & Medicaid Services (CMS) signed contracts last week with the incumbent RAC contractors to provide limited Recovery Audit services through April 30, 2016, according to Monitor Mondays legislative analyst Emily Evans.  Evans, a partner with the Obsidian Research Group, said the contracts, valued at around $200,000, would be for limited RAC services.  “RACs will be permitted to handle...

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08.21.2014
Getting Centered
Getting Centered

Today’s hospitals have to do a lot more with a lot less. Obviously, organizations would rather focus on patient care and not red tape. But the reality is that hospitals must spend more and more time lately on back-end administrative processes – including compliance, audit management, and denials – in order to direct more dollars to the front end. Many hospitals...

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08.06.2014
Senate Hearing Confused by Outdated Rules
Senate Hearing Confused by Outdated Rules

I am opposed to the Eighteenth Amendment to the U.S. Constitution, which prohibits the manufacture, transportation, and sale of alcohol. I think that prohibition has done more harm than good and that alcohol should be legal to sell and consume in the United States. I therefore call on Congress to hold hearings on repealing the Eighteenth Amendment. Oh, wait, it was...

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08.06.2014
Another Band-Aid, Please: Treating the Symptoms, Not the Disease
Another Band-Aid, Please: Treating the Symptoms, Not the Disease

A few weeks ago, the Office of Medicare Hearings and Appeals (OMHA) announced what it described as a way to clear up the current federal backlog of appeals and move the process forward more efficiently. Of particular interest is the Statistical Sampling Pilot Program. Also of some interest is that the Centers for Medicare & Medicaid Services (CMS) has been conducting...

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OIG

OIG Releases “Robust” Work Plan to Tackl…

Janis Oppelt | 02.06.2014

OIG Releases “Robust” Work Plan to Tackle New Healthcare Market Place

Millions of people who were previously uninsured will gain health insurance coverage in 2014, thanks to the Patient Protection and Affordable Care Act (ACA) of 2010. The ACA, which enacted...

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Feature Articles

Providers Weigh in on ALJ Appeal Delay

Chuck Buck | 01.23.2014

Providers Weigh in on ALJ Appeal Delay

Providers were quick to react to the decision by the Office of Medicare Hearings and Appeals (OMHA) to suspend new hearing requests for two years. In an OMHA memo obtained by...

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IRF

Site-Neutral Payments: A June 2014 MedPA…

Angela Phillips, PT - avatar Angela Phillips, PT | 07.03.2014

Site-Neutral Payments: A June 2014 MedPAC Report

The June 2014 MedPAC report to Congress included information on the commission’s review and recommendations for site-neutral payment when rehabilitation of certain conditions occurs in different post-acute-care facilities. The report...

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