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Under the Medicare OPPS, hospitals must report all HCPCS codes and charges for separately payable drugs in addition to reporting applicable drug administration codes. Drugs are billed in multiples of the dosage specified in the HCPCS code long descriptor....
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EDITOR'S NOTE: Cheryl Servais recently returned from South Africa, which she visited as a member of a delegation from the Healthcare Financial Management Association (HFMA) under the leadership of President and CEO Richard L. Clarke, DHA, FHFMA. Servais...
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Fall is a great time of year.If you live in Florida, you finally can open up your windows for some fresh air. If you live in New England, you are basking in the beauty of the changing leaves. If you live in the mountains, you are hoping for an early sn...
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The RAC program is just one of the CMS programs designed to ramp up "benefit integrity" efforts and to otherwise preserve or recoup cash for the trust fund. Providers must be aware of all the alphabet soup measures. Be prepared for the Zone Program ...
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Nurse Auditor
ED NOTE: Meet Patty Clark, RN, BSN, who became the Nurse Auditor responsible for appealing medical necessity denials in 2007 when the RAC demonstration program was at its height.
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Imagine a state of healthcare in which there's no coding, no billing and, of course, no RACs. In their place, insurance schemes.
Roll that thought around in your mind as you monitor the healthcare reform debate simmering in Congress. Better yet, sp...
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"The bad news is time flies. The good news is you're the pilot."-Michael Althsuler
Do we need flying lessons to pilot our way through the new RAC world? Are we using time to our advantage?
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Nearly two years after the RAC demonstration program took place, where do we stand?
Since the March 2008 completion of the RAC demonstration program, there have been varying degrees of activity within the hospital community when it comes to quantifyin...
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We talk a lot about the increased scrutiny and risk that hospitals face today from third-party payers and Medicare and Medicaid contractors, including RACs, MACs, ZPICs, MICs and the Office of Inspector General.
Especially in the current economic cli...
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To this point of the RAC preparation process, I have been very impressed with the proactive efforts of many hospitals.
Some have done their own data mining to determine potential risk areas; some have analyzed medical record documentation to assess c...
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(October 6, 2009) --- The Centers for Medicare & Medicaid Services (CMS) has announced that it will hold what it describes as a "town hall meeting" conference call on Thursday, November 5, on appeals of Medicare payment denials under Section 935 o...
