Special Bulletin

December 7, 2017

New Hampshire Physician Loses Medical License

By Denise Nash, MD, CCS, CIM
Small town physician loses license because she doesn’t use a computer in her practice. Am I the only one who remembers Marcus Welby, MD? For those of you that don’t remember, he was a family practitioner on a TV show back in the 70s who knew all his patients by…
Proprietary algorithm to determine “correct” code and change claim. It’s clearly a new age in the coding of emergency department (ED) visits – after all, one insurance giant is reportedly looking to take the human element out of the equation completely. ED facility coding and auditing seems to be a…
The lawsuit was filed as an alleged violation of the federal False Claims Act. A recently unsealed federal whistleblower lawsuit alleges that dozens of Indiana hospitals engaged in a pattern of overcharging patients for their electronic medical records (EMRs), according to a recent report in Becker’s Hospital Review. The report…
As it pertains to an important issue first raised in October 2016, CMS last week made a key change, effective Jan. 1, 2018. In a surprise move last week, the Centers for Medicare & Medicaid Services (CMS) agreed to pay for outpatient dialysis for patients with acute kidney failure (AKI)…
Low-Volume Appeals (LVA) and expansion of its Settlement Conference Facilitation (SCF) program are two new offerings by the Office of Medicare Hearings and Appeals (OMHA) to improve the appeal process. In an effort to improve the Medicare appeal process, hospitals are being offered two new programs – one designed for…
The action by CMS to remove total knee replacement from the inpatient-only was not unexpected in the 2018 OPPS final rule released on Wednesday.  In a surprised move the Centers for Medicare and Medicaid Services (CMS) released the Outpatient Prospective Payment System (OPPS) final rule Wednesday rather than on Friday…
Release of outdate guidelines raises fears that other MACs might adopt them to audit providers. The use of outdated definitions of malnutrition by a Medicare Administrative Contractor (MAC) is raising concerns that other MACs may adopt the same flawed practice. The universally accepted definitions, known as the American Society for…
Report offers peek behind the curtain at financial picture. The Centers for Medicare & Medicaid Services (CMS) just released a preliminary report outlining the first-year results of the Comprehensive Care for Joint Replacement (CJR) program. The report on the first mandatory “bundled payment” program reveals that participating hospitals were able…