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CMS Issues Final Rule on MA, Part D  

CMS Issues Final Rule on MA, Part D

Mark Spivey
By Mark Spivey

Estimated savings are $75 million over a decade.

Federal officials recently announced a series of changes to the Medicare Advantage (MA) and Part D prescription drug programs they hope will save tens of millions of dollars and also allow beneficiaries to make more informed purchasing choices.

The ...

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Medicare Inpatient Pricer Now Available

Medicare Inpatient Pricer Now Available

Ronald Hirsch, MD
By Ronald Hirsch, MD

The data may allow you to better understand the intricacies of hospital payments.

When I teach Medicare regulations to physician advisors, case managers, and utilization review professionals, it is always interesting to see the reactions when I explain how Medicare calculates how much to pay for ...

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A Study of Contractor Consistency in Reviewing Extrapolated Overpayments

A Study of Contractor Consistency in Reviewing Extrapolated Overpayments

Frank D. Cohen, MPA, MBB
By Frank D. Cohen, MPA, MBB

CMS levies billions of dollars in overpayments a year against healthcare providers, based on the use of extrapolation audits.

The use of extrapolation in Medicare and private payer audits has been around for quite some time now. And lest you be of the opinion that extrapolation is not appropriate ...

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    The Big Apple's Cyber Nightmare

    The Big Apple's Cyber Nightmare

    Edward Roche, PhD, JD
    By Edward Roche, PhD, JD

    Failure to integrate information systems leaves New Yorkers seeking COVID-19 vaccination out of luck.

    EDITOR’S NOTE: This is the first in a series of articles called “Cyber Watch,” produced by RACmonitor and authored by Edward Roche.

    New York City is supposed to be one of the most advanced data ...

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