Blog

The late Marvin Gaye’s 1971 hit “What’s Going On?” gives us reason to pause in contemplating two reports this week on the Centers for Medicare & Medicaid Services’ RAC program. The RACTrac report researched and published by the American Hospital Association for the third quarter of 2013 reveals that the…
The fate of critical access hospitals (CAH) was discussed during Monitor Monday in reaction to the recent OIG report suggesting that two-thirds of the nation's CAHs would not meet the milage requirement (35 miles) if they were to re-enroll in the Medicare program today. The special guest today was Brock…
On Monitor Monday today, Emily Evans, partner at Obsidian Research Group reported that CMS has notified the RAC’s that they will stop making ADR’s on November 15, 2013. On January 30, 2014, the RAC’s are to stop sending improper payment claims to CMS. Because the RAC re-procurement remains up in…
CMS has posted the final rule for Part B payment for hospital inpatient services provided under Part B, Medicare’s inpatient admission guidelines, and medical review criteria for inpatient stays. Although the effective date of this final rule is Oct.1, hospitals are allowed to follow the Part B billing timeframes established…
The Centers for Medicare & Medicaid Services (CMS) reportedly is developing a new integrity contractor called a Unified Program Integrity Contractor (UPIC). These contractors will focus on both Medicare and Medicaid integrity issues, and the Zone Program Integrity Contractors (ZPICs) and the Medicare Administrative Contractors (MACs) will be folded into…
In our recent two-part series on Monitor Monday, we asked providers if they were in favor of Congress creating a designation of "most favored nation status" to those providers who did not cheat Medicare or Medicaid. Most agreed. But there surfaced a contrarian point of view. Patrick, a frequent listener,…
We conclude our exclusive two-part series with a unique, one-hour “town hall” broadcast when we reveal, discuss, and analyze the comprehensive survey conducted by RACmonitor in association with Obsidian Research and the Frank Cohen Group. Emily Evans from Obsidian Research, who was on Monitor Monday last week, will describe the…
Should providers who play by the Medicare payment rules be granted "most-favored nation" status, as U.S. Sen. Max Baucus, D-Montana, seemed to indicate during a recent hearing of the Senate Finance Committee focusing on the RACs? In a report to investors, Emily Evans used the phrase "most-favored nation" to describe…