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The legislation raises questions regarding logistics. As residents of the U.S. Southeast prepare for Hurricane Dorian, which is expected to skirt the coast today, bringing with it hurricane-force winds and storm surges, providers there have something else to worry about as well: the MOON (Medicare Outpatient Observation Notice). As reported…
August 29, 2019

New Nursing Home Payments Under PDPM

By Timothy Powell, CPA CHCP
HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients. In 2016, there were 15,807 deaths among…
August 21, 2019

How a Texas Health System Beat a $61.8 Million Billing Fraud Case

By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
The allegations in the case focused on CCs and MCCs. EDITOR’S NOTE: This story appeared Aug. 20, 2019, in the ICD10monitor news. A Texas federal judge recently dismissed a False Claims Act lawsuit alleging that Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims. The whistleblower lawsuit, filed…
If implemented, physician supervision will have come almost full circle. The Centers for Medicare & Medicaid Services (CMS) has almost come full circle on the issue of therapeutic hospital outpatient physician supervision requirements. With the issuance of the OPPS/APC (Outpatient Prospective Payment System/Ambulatory Payment Classification) Federal Register on July 29,…
Protecting patient rights is one of the cornerstones of Medicare policy. As a doctor, I can assure you that I would rather patients concentrate on their health and not worry about whether their medical providers or their insurers are making decisions for them based on considerations that are not in…
Case managers could be at risk relative to discharge planning. While not significantly common, hospital case managers have been named in nursing malpractice suits, primarily in association with discharge planning. Attorneys Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. from The Health Law Partners, P.C. discussed this issue and other…
An interview with a subject matter expert sheds light on one of healthcare’s trendiest topics. Editor’s Note: Ellen Fink-Samnick is a member of the RACmonitor editorial board and a permanent panelist on Monitor Mondays whose areas of expertise include the social determinants of health (SDoH). Chuck Buck recently conducted an online interview with…
Swing vote by Chief Justice John Roberts reflects his support of judicial precedent. On June 26 the U.S. Supreme Court issued a decision (https://www.supremecourt.gov/opinions/18pdf/18-15_9p6b.pdf)  on how courts should handle ambiguous government regulations.  Many people, including me, expected that the case would change the level of deference courts grant to a…