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The Center of Medicare and Medicaid Service (CMS) continues to develop a growing portfolio of various payment and service delivery models across the nation that aim to achieve better care for patients, better health for our communities, and lower costs through improvement for our healthcare system. That said, the rural…
A former high-ranking official with a health insurance industry titan has filed a whistleblower lawsuit alleging that Medicare Advantage annually made tens of billions of dollars in improper payments to insurers over the course of years, the New York Times reported last week. Benjamin Poehling, a Minnesota resident who once…
In early 2017, a federal Judge blocked a Centers for Medicare & Medicaid Services (CMS) interim final rule regarding premium assistance for end-stage renal disease (ESRD) patients. CMS did not technically bar ESRD patients from getting help with premiums. The agency was simply concerned with the inappropriate shifting of this…
In 2009, the headlines read that rural children’s mental health was being overlooked and disregarded.” Fast forward nearly 10 years, and the headlines still remain more or less the same, even in the days leading up to this week’s Children’s Mental Health Awareness Day. It is tragic that today more…
April 26, 2017

Expect Final Decision on Appeal Cases to Take Years

By Charles Locke, MD, CHCQM-PHYADV
For those for you who are regular listeners to Monitor Mondays, you heard Dr. Ronald Hirsch in his April 10 ”Monday Rounds” segment discuss an article recently published online by the Journal of Hospital Medicine detailing the appeal process of Recovery Audit Contractor (RAC) denials at three academic hospitals. I…
With a mission to improve rural healthcare access and outcomes for underserved populations through innovation and promising practices, the role of community health workers (CHWs) is rapidly evolving across rural areas, having been recognized by the U.S. Department of Labor as an essential part of the cost- effective delivery of…
Indeed, it was another “Dantastic” Monday as Inspector General Dan Levinson took the podium to deliver the keynote at the 21st Annual Compliance Institute in National Harbor, Maryland.  Dan opened with the discussion of a January Health Care Compliance Association (HCCA) U.S. Department of Health and Human Services Office of…
I recently attended the Health Care Compliance Association’s (HCCA) Compliance Institute (March 25-29, 2017) in National Harbor, MD, where healthcare compliance experts gathered to discuss the challenges faced in today’s complex regulatory environment. From there, a short ride to Washington, D.C., took me to the annual HIPAA Summit (March 29-31,…