Special Bulletin

The nation’s largest healthcare conference has been canceled amid the growing threat. The deadly coronavirus (COVID-19) has resulted in the cancellation of HIMSS20, the 2020 healthcare IT conference initially scheduled to take place next Monday in Florida, according to an announcement on the association’s website. “Following reports from the WHO…
Global cases are approaching 100,000 as the U.S. braces for the worst. The Centers for Medicare & Medicaid Services (CMS) has suspended non-emergency facility inspections nationwide as a measure to free up resources to focus more acutely on the COVID-19 respiratory virus, officials announced on Wednesday. “CMS is committed to…
CMS says MOON errors will not affect billing/payment. EDITORS NOTE: This article is an update from last week's article Erroneous Guidance by NGS Could Pose Problems for Hospitals. Observation hours will not be removed from claims if hospitals fail to accurately complete and deliver to patients the Medicare Outpatient Observation…
Are MACs going rogue? According to a webinar held last week, NGS, the Medicare Administrative Contractor (MAC), has taken the targeted probe-and-educate audits (TPE) to an area one would never expect: the proper completion and delivery of the Medicare Outpatient Observation Notice (MOON), the Centers for Medicare & Medicaid Services…
The OIG has instructed MACs to recoup the entire DRG payment on claims dating back to 2016. EDITOR’S NOTE: The RACmonitor special bulletin of Jan. 30, “News Alert: Widespread Recoupments of Incorrect Post-Acute Transfer Claims Have Begun,” is prompting alarm among hospitals, as evidenced by the response from Dr. R.…
At issue: hospital overpayments of $54.4 million. There has been recent talk on an online user group that many hospitals have had recoupments of payment for inpatient admissions from 2016 to 2018 due to an “incorrect discharge status code.” This appears to be in response to a November 2019 audit…
Same old New MOON, but potential problems appear in two of the other three new forms. All federal forms require periodic review and reapproval by the Office of Management and Budget (OMB). The approval is indicated on the form by a unique number and an expiration date. The Centers for…
UnitedHealth says it will use proprietary software to deny claims. EDITOR’S NOTE: The topic of this article was previously covered by RACmonitor on separate occasions in 2017 and 2018. To welcome the new year, UnitedHealthcare (UHC) has announced that starting April 1, 2020, they will use a proprietary software program…