Special Bulletin
December 20, 2019
Special Bulletin: OIG Looks at Medicare Advantage Risk Score Audits
By Timothy Powell, CPA CHCP
MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a study that should cause a chill to run down the spines of hospital and Medicare Advantage plan leaders alike.…
November 29, 2019
News Alert: Day of Reckoning Has Arrived for Discharge Planning Conditions of Participation
By Chuck Buck
Compliance is mandatory, but data from CMS remains unavailable at this time. The discharge planning day of reckoning is today, Black Friday, Nov. 29, 2019 – and yet, as of this reporting, the only source of data, the Centers for Medicare & Medicaid Services (CMS) Compare website, still has no…
November 27, 2019
Discharge Planning Conditions of Participation Final Deadline Approaching
By Mary Beth Pace, RN, BSN, MBA, ACM, CMAC
Final rule becomes effective Friday, Nov. 29, 2019 EDITOR’S NOTE: The following are edited remarks by Mary Beth Pace, the author who was a panelist on Monitor Mondays Nov. 25, reporting on how Trinity Health is preparing to implement the final rule on discharge planning conditions of participation from the…
November 18, 2019
“Shoppable Services” Identified by CMS in Final Pricing Rule
By David M. Glaser, Esq.
EDITOR’S NOTE: Healthcare attorney David Glaser reported on the CMS final rule’s reference to “shoppable” services during today’s edition of Monitor Monday. The following is his report. On Nov. 15, the Centers for Medicare & Medicaid Services (CMS) released an advanced copy of a final rule that will require all…
November 15, 2019
BREAKING: Feds kick healthcare hornet’s nest with twin rules pledging price transparency
By Mark Spivey
The announcement covers OPPS, ASC regulations, and promises to ramp up competition among providers. In a move that sparked instant and intense reactions across the healthcare industry, the federal government on Friday introduced twin final rules it says constitute “historic steps” to increase price transparency and increase competition among the…
November 4, 2019
News Alert: CMS releases MPFS Final Rule, policies governing OPPS/ASC payment systems
By Mark Spivey
Final Rule covers a wide range of payment and other provisions. The Centers for Medicare & Medicaid Services (CMS) wrapped up last week by unveiling a final rule associated with the Medicare Physician Fee Schedule (MPFS) and new policies governing the functions of the payment systems for the Outpatient Prospective…
The proposed changes target the federal Physician Self-Referral Law and the Anti-Kickback Statute. The U.S. Department of Health and Human Services (HHS) is introducing proposed changes to “modernize and clarify” the regulations that interpret the Physician Self-Referral Law (the “Stark Law”) and the federal Anti-Kickback Statute, officials announced Wednesday. The…
September 26, 2019
Preliminary injunction filed in federal court on behalf of providers dismissed from Virginia Medicaid program
By Mark Spivey
More than two dozen providers are listed as plaintiffs, with more expected to join. More than two dozen Virginia behavioral healthcare providers have filed a preliminary injunction in federal court to halt and reverse their recent sudden, unexpected dismissal from the state’s Medicaid ranks at the hands of six…
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Editorial Board
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Allen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAmber Soucy, MSN, RNAndrew B. Wachler, Esq.Andrew B. Wachler, Esq. and Emma E. TrivaxAndrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler and Kaitlin NucciAndrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTAspen AlbrightBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBenjamin Kartchner MD, CHCQM-PhyAdvBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckClark AnthonyColleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RNDaniel Zirkman, MDDavid A. McKenzie, CAEDavid Jury MD, MSDavid M. Glaser, Esq.Delilah Davis, RN, BSN, CCADenise Coleman, LPNDenise Nash, MD, CCS, CIMDheeraj Mahajan, MD, FACPDuane Abbey, PhD, CFPEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVEllen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPEllen Parucka Walker LCSW ACSWErica E. Remer, MD, FACEP, CCDSErin Diesel Roumayah, Esq.Frank D. Cohen, MPA, MBBGlenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAMGloryanne Bryant, RHIA, RHIT, CCS, CCDSGreg FordHolly Louie, RN, BSN, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John K. Hall, MD, JD, MBA, FCLM, FRCPCJulia K. Brodt, PhDJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKathleen K. Borchard, BSN, RN-ACMKathy Seward, MD, CHCQM-PHYADVKim T. Charland, BA, RHIT, CCSKnicole C. Emanuel Esq.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerLaurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS TrainerLeslie Marsh, RN, BS, MSN, MBALori O’Hara, MA, CCC-SLPMadison AllenMaggie Elehwany, JDMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Anne Hayes Hartman, Esq.Mary Inman, Esq. and Max Voldman, Esq.Matt Lambert, MDMatthew AlbrightMaureen Testoni Esq,Max Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael KennedyMichael Rosen, Esq.Nancy J. Beckley, MB, MBA, CHCNena Scott, MSEd, RHIA, CCS, CCS-P, CCDSPhillip Angello, MDRalph Wuebker, MD, MBARichard “Dick” Beckley, YNS, USN, 1966-1970
