Special Bulletin
September 18, 2017
News Alert: Is Humana Putting Profits Before Patient Safety?
By Ronald Hirsch, MD, FACP, CHCQM
Late last week a case management colleague distributed an insurance company memo that had been sent to her hospital to a Recovery Audit Contractor- (RAC)-related user group. This memo required a double-take to ensure that it was not five months old, because it should have been distributed on April Fools’…
August 28, 2017
News Alert: Policy Contradiction Requires Physicians to Personally Supervise Therapeutic Pheresis
By Ronald Hirsch, MD, FACP, CHCQM
In another example of Medicare Administrative Contractors (MACs) contradicting the Centers for Medicare & Medicaid Services (CMS), National Government Services (NGS) on Friday issued a news and alert bulletin that was both controversial and confusing. In the alert, NGS stated that outpatient therapeutic pheresis procedures “must be performed by physicians…
EDITOR’S NOTE: Nancy Beckley served as an invited member of the Jimmo Implementation Counsel convened by the Center for Medicare Advocacy. The therapy community, as well as those providing medically necessary skilled maintenance, now have a centralized online resource for information on the Jimmo v. Sebelius Settlement. The Centers for…
August 21, 2017
News Alert: Friday’s Landmark Fraud Case Highlights Need for Checks, Balances on Repayment Demands
By Frank D. Cohen, MPA, MBB
In May 2016, a landmark healthcare fraud case resulted in a federal jury convicting Florida-based Dr. Ona Colasante of 162 counts of healthcare fraud. The government’s claim was that she billed for services that were either unnecessary or not provided at all, and purchased drugs that, while identical to those…
The Centers for Medicare & Medicaid Services (CMS) unveiled the new Hospice Compare website on Wednesday. According to CMS, the site displays information in a ready-to-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. In its announcement Wednesday, CMS said the Hospice…
August 15, 2017
Breaking: CMS Adopts Targeted Probe and Educate Policy Nationwide
By Ronald Hirsch, MD, FACP, CHCQM
The Centers for Medicare & Medicaid Services (CMS) announced Monday that it would start a new national audit strategy titled Targeted Probe and Educate (TPE) after pilot programs with four Medicare Administrative Contractors (MACs) demonstrated success. CMS described that success as “including an increase in the acceptance of provider education…
August 14, 2017
Breaking: Future of Value-Based Payments in Doubt as CMS Cancels Major Episode Payment Rule
By Ronald Hirsch, MD, FACP, CHCQM
It has become evident over the last several years that the Centers for Medicare & Medicaid Services (CMS) has been changing the trajectory of the provision of medical care in the U.S. from a system based on increasing revenue by increasing volume to a system based on rewarding providers for…
While hospitals are continuing to wonder when the Recovery Audit Contactors (RACs) are going to be given approval to start auditing short-stay inpatient admissions, the RACs continue to expand their non-admission status targets. Last week, two of the RACs, Cotiviti and Performant, received approval to audit hospitals for the use…
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Editorial Board
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Allen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAndrew B. Wachler, Esq.Andrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler and Kaitlin NucciAndrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckDaniel Zirkman, MDDavid M. Glaser, Esq.Denise 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, CRPErica 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, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John K. Hall, MD, JD, MBA, FCLM, FRCPCJuliet 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, FAHIMALori O’Hara, MA, CCC-SLPMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Max Voldman, Esq.Matthew AlbrightMax Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael Rosen, Esq.
