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New guide offers the possibility of improving a hospital’s bottom line. Last week, The National Quality Forum and the American Hospital Association Center for Health Care Innovation released their how-to guide for hospitals and health systems seeking to implement, strengthen, and sustain tele-behavioral health. Entitled Redesigning Care, the guide outlines an…
Two dozen individuals were charged in a landmark investigation historic in breadth. “A million dollars isn’t cool,” remarked pop star Justin Timberlake in the Oscar-winning 2010 film The Social Network, portraying entrepreneur Sean Parker as he advises a young Mark Zuckerberg and his associates in a nightclub amid the fledgling…
The head of the federal healthcare oversight body was a popular guest on Monitor Mondays. Daniel Levinson, Inspector General of the U.S. Department of Health and Human Services (HHS), is stepping down from his post at the end of May, following nearly 15 years in his position as healthcare’s top…
March 28, 2019
Beware: The MIPS Shell Game
By Larry Field DO, MBA, CHCQM, CPC, CHC, LHRM, ICD10 CM/PCS Trained, Baldrige Trained
Weighting changes will be implemented for the 2019 calendar year. Important changes for the 2019 calendar year in healthcare include Merit-Based Incentive Payment System (MIPS) category weighting changes. The quality category will decrease in importance, with a shift of 5 percent, going from 50 to 45 percent of the overall…
New CMS pharmacy dashboards include data sets from 2013 to 2017. The Centers for Medicare & Medicaid Services (CMS) has released its latest “CMS Drug Spending Dashboards.” While the dashboards are interactive (you can look up specific drug data), we took a broader approach and downloaded and analyzed the source…
Hiring a consultant can be a high-risk activity. Don’t get me wrong; I am definitely not disparaging consultants in general. A good consultant can get you out of a jam. I regularly rely on the wisdom of consultants, including my fellow RACmonitor authors and Monitor Mondays panelists, while assisting clients. But as…
Medicare has not been paying its fair share of medical costs for decades. Medicare for all: what would it do to hospitals? Hospital CFOs tell us that Medicare does not pay as much as other payers, and that Medicare for all would result in many hospitals closing. To answer this…
February 21, 2019
Medicare Audit Contractors Demand Providers Perform Self-Audits
By Edward Roche, PhD, JD
Although the details of federally ordered auditing of providers have changed over the years, one thing remains the same. We have lived for years under the Sword of Damocles – the continuing waves of healthcare audits by federal contractors. The names of the Medicare Recovery Audit Contractors (RACs) have changed…
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