Filter  MonthJanFebMarAprMayJunJulAugSepOctNovDec Year20022003200420052006200720082009201020112012 5101520253050100All Filter

• OIG Targets CMS Failures to Address Vulnerabilities

  Created: Tuesday, 20 December 2011 12:43 Author: Mark Spivey, Contributing Writer

  WASHINGTON, D.C. - As of January 2011 the Centers for Medicare & Medicaid Services (CMS) had failed to resolve or even take any meaningful action to address 77 percent of vulnerabilities identified by contractors in 2009, according to a recent study b...

• Hospitals Settle False Claims Allegations

  Created: Monday, 19 December 2011 09:56 Author: Karen Long

    Two hospitals have settled allegations of overcharging the government for infusion therapy and lithotripsy services, the U.S. Attorney for eastern California announced Dec. 7.   Sutter Health Association paid more than $1.4 million for the 25 nor...

• Latest RAC Findings: Improper Inpatient Coding of Coronary Bypass Procedures

  Created: Wednesday, 14 December 2011 00:00 Author: Kim T. Charland, BA, RHIT, CCS

  Inpatient hospitals are improperly coding coronary bypass with percutaneous transluminal coronary angioplasty (PTCA) with major complications and comorbidities (MCCs) (MS-DRGs 231, 233, and 235), according to the October issue of the Medicare Quarterly Pr...

• Happy Holidays from RAC Monitor

  Created: Wednesday, 14 December 2011 00:00 Author: Chuck Buck

  Adobe Flash Player not installed or older than 9.0.115!
  

    ...

• RAC Regions A, D Post Issues

  Created: Wednesday, 14 December 2011 00:00 Author: Karen Long

                  HealthDataInsights, the RAC for Region D, posted five issues for inpatient hospitals last week. HDI cited CMS’s Medicare Benefit Policy Manual chapter one (Inpatient Hospital Services Covered Under Part A) and chapter...

• The Essential Requirements for Effective Utilization Review

  Created: Tuesday, 13 December 2011 10:56 Author: Donna McLean, RN, MBA, CMAC

  EDITOR'S NOTE: This is the third installment of a four part series on Utilization Management Plan.   The heart of a good utilization management (UM) plan gives operational direction to the case management team and physician advisors performing the util...

• Medicare Enrollment: Will This Become a RAC Issue?

  Created: Tuesday, 13 December 2011 10:10 Author: Duane Abbey, PhD, CFP

    Enrollment in the Medicare program progressively has become more involved over the years. This process is accomplished through the use of various CMS-855 forms. On July 1, 2011 CMS quietly updated the CMS-855 system and switched from five different ...

• New Opportunities for RAC Auditors as the OIG Expands the Work Plan for 2012

  Created: Tuesday, 13 December 2011 09:40 Author: Jana Gill, MA, CPC

  The OIG in 2012 will continue to address previous years' problem areas, but it currently appears to be taking a closer look into physician billing, specifically the use of modifiers that impact reimbursement.   In the 2011 Work Plan, the OIG identified...

• Hospitals Play a Key Role in Preventing Exposure-Related Injuries for People Experiencing Homelessness

  Created: Monday, 12 December 2011 00:00 Author: Sabrina Edgington

      This part of the year is particularly harsh for people who lack housing.   If not employed, the days are often spent looking for a warm place to rest, nutritious and warm food to nourish the body, and above all, a place to stay for the night....

• Doctor, People from Craigslist Posing as Docs Sentenced

  Created: Sunday, 04 December 2011 10:56 Author: Karen Long

                A New Jersey doctor has been sentenced to more than three years in prison after sending people posing as physicians to perform more than 20,000 patient visits.Some of the people that Yousuf Masood, 47, of Warren, N.J., had po...