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Proliferation of RAC Meaningful Use Audits

Proliferation of RAC Meaningful Use Audits

Knicole C. Emanuel Esq.
By Knicole C. Emanuel Esq.

In this case, more than 50 percent of the practice’s patients refuse to provide an email address or do not have one to provide.

Recently, I’ve seen a slew of meaningful use audits. Hospitals go through these audits all the time. It usually goes like this: a hospital purchases an expensive ...

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Death of the Inpatient-Only List is NOT the Death of Medical Necessity

Death of the Inpatient-Only List is NOT the Death of Medical Necessity

Marvin D Mitchell, RN, BSN, MBA
By Marvin D Mitchell, RN, BSN, MBA

The Medicare IPO list was doomed years ago.

For readers of and listeners to RACmonitor and Monitor Mondays, overthinking things is what we do. It’s the only explanation for our hand-wringing over the death of the Medicare inpatient-only (IPO) list. 

To be clear, ending the IPO list is completely ...

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Gatekeepers of the ED

Gatekeepers of the ED

Marie Stinebuck, MBA, MSN, ACM, and Tiffany Ferguson, LMSW, ACM
By Marie Stinebuck, MBA, MSN, ACM, and Tiffany Ferguson, LMSW, ACM

A true gatekeeping process for ED admissions does not always exist.

The decision to admit a patient from the emergency department (ED) to a hospital bed is one of the most expensive healthcare decisions. As payers continue to decrease payments for hospitalizations and as more diagnoses move to the ...

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Kickbacks in the Medicare Advantage Program: $12.5 million Settlement in Whistleblower Case

Kickbacks in the Medicare Advantage Program: $12.5 million Settlement in Whistleblower Case

Mary Inman, Esq. and Max Voldman, Esq.
By Mary Inman, Esq. and Max Voldman, Esq.

The first of its kind FCA case involves Roche and Medicare Advantage insurer Humana.

The recent settlement of a whistleblower case involving the government’s Medicare Advantage program might be a sign of things to come for litigation filed under the False Claims Act (FCA), including those ...

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    Life Expectancy Trends: SDoH Impose Trauma amid the Pandemic

    Life Expectancy Trends: SDoH Impose Trauma amid the Pandemic

    Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
    By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

    Drug overdose deaths were another influencer.

    Amid last week’s hottest reports was new data from the National Center for Health Statistics. While it was expected that COVID-19 would dramatically impact life expectancy across populations, the data for those persons most vulnerable was alarming.

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