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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.
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With a stroke of pen, President Obama last Friday signed into law the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010," which among other provisions, clarifies Medicare's policy for payment of services provided i...
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I've seen documentation errors and omissions that clearly put hospitals and physicians at risk for denials. What's more, as I review medical records from across the country, I'm starting to see patterns of errors at individual hospitals and by individua...
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The Recovery Audit Contractor for Medicare's Region B, CGI Federal, late Wednesday posted 87 new DRG Validations in 10 approved issues, capping a 10-day period that witnessed a total of 126 new DRG Validations and new patient E & M codes from all four...
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CMS is reporting that providers are winning favorable decisions on appeals 64.4 percent of the time since the launch of the demonstration through March 9, 2010.
In its Update to the Evaluation of the 3-Year Demonstration, issued last week, CMS report...
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Three RACs have all posted new issues in the past two weeks. Medical necessity reviews are still not approved. The new issues are listed below:
Region A
The RAC for Region A (DCS) posted several new issues, mostly for Automated Review:
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ED. NOTE: Nancy Beckley enchanted Monitor Monday listeners recently with her “Post Cards on the Edge,” in which she tersely, albeit affectionately describes her travails in the realm of inpatient rehabilitation compliance.
Dear Mom,
Well b...
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ED. NOTE: RACmonitor continues with its ongoing coverage of the 72 Hour Rule as it makes its way through the legislative process. You will find the most recent updates at racmonitor.com. Here is the latest in a continuing series on the 72 Hour Rule fr...
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By Andrew B. Wachler, Esq. and Jesse Adam Markos, Esq.
Recovery Audit Contractors ("RACs") are required to participate in a discussion period if the provider submits a timely request.
Many providers may be skeptical about the value of this discu...
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"Can You Hear Me (Us) Now??!"
I wish I had coined that phrase years ago! So many of us responsible for education, training and consulting within the healthcare industry feel that we sometimes speak to deaf ears regarding some basic components rel...
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Under the DRG reimbursement system, prior to 2008, hospitals treating more severely ill patients in certain DRGs than those of the average hospital often did not receive payment levels commensurate with the costs of treating such patients. Accordingly, CM...
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The Government Accountability Office (GAO) recommends that audit contractors' post-payment review activities could be more valuable if CMS directed these contractors to focus on items and services where RACs are not expected to focus their reviews, ...
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Senate Majority Leader Harry Reid (D-NV) has indicated that debate on H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, could begin in the Senate as early as today, Tuesday, June 8.
The Senate bill, however, will be subject to amend...
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Clinical Documentation Improvement (CDI) can be defined as the practice of ensuring that all service, treatment and evaluation of patient care is captured and reflected accurately in physician documentation.
In essence, Clinical Documentation Special...
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The recently released Department of Health and Human Services' Estimated Financial Effects of the Patient Protection and Affordable Care Act (the "Report") concludes that healthcare reform will cover more people and cost $828 billion over the next decade....
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Do you know how to review your Medicare remittance advice, or RA, for Recovery Audit Contractor (RAC) activity and accurate financial data?
And, perhaps more importantly, do you actually do it? It's a task that physicians, providers, and suppliers su...
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ED. NOTE:
The following is the first in an occasional series of articles from the field, reported by Anissa Fabrizio, the Administrative Director of Health Information Management and Patient Access for St. Anthony Hospitals, part of Centura Health.
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If only physicians would make a habit of utilizing the word "because" in their documentation. I review medical records from our hospital clients across the country and get to see firsthand how poor physician documentation can lead to denials. Some doctors...
