News

EDITOR’S NOTE: Lisa Banker, MD contributed to the following report. Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable organization determination when denying or recouping part or all of a payment from a non-contracted provider. The directive came in the form of a Centers…
September 24, 2020

Mixed Federal Messaging on COVID

By Matthew Albright
Congress appears to be closer on a COVID-19 relief package. U.S. Supreme Court Associate Justice Ruth Bader Ginsburg passed away on Friday. Ginsburg was the second woman appointed to the Supreme Court, serving there for 27 years. We mourn her loss, and as a country, we are grateful for her…
September 24, 2020

The Impact of COVID on the Social Determinants of Health

By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
Food insecurity is on the rise. Amid the perils of the continuing COVID-19 pandemic are now growing concerns about food shortages around the country. Since COVID began, the U.S. Census has been tracking the impact of the associated economic crisis on the public. The numbers are important for healthcare organizations…
September 24, 2020

Provider Audits Hit the Ground Running Following Pause

By Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P
Medicare audits expected soon.Federal healthcare audits have resumed, and they are not limited to durable medical equipment (DME) or any one specific group of providers, any one type of contractor, or any one specific locality in the country. Since the announcement of the ramping up by the Centers for Medicare…
September 24, 2020

Five Data Analytics Metrics That Help Prevent and Manage Denials

By Robin Sewell, CDIP, CCS, CPC, CIC
Your data will determine the overall success of your denial prevention and management efforts. No matter how robust the clinical documentation integrity (CDI) program, there are still payer denials. Payer audits become more creative and voluminous each day. Just when we think we have a handle on the top clinical…
September 22, 2020

News Alert: CMS Orders Halt to Loan Repayment

By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
Action applies to the Medicare Accelerated and Advanced Payment Loan Program.  In March, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and Advanced Payment Program (AAP) due to the COVID-19 public health emergency (PHE), in an effort to increase cash flow to providers. Under the current terms, repayment for…
September 18, 2020

CMS Issues Early Release of MA Advance Notice

By Mark Spivey
The move contrasts with shorter timelines associated with the releases of the IPPS, OPPS rules. In an apparent effort to make providers’ lives a little easier, federal officials earlier this week issued Part I of the 2022 Medicare Advantage (MA) Advance Notice of proposed payment changes. “This announcement of Medicare…
Two payers allegedly inflated their bids. Earlier this month, two Independence Blue Cross (IBC) subsidiaries in Pennsylvania agreed to pay $2.25 million to resolve allegations that they defrauded the Medicare Advantage (MA) program and violated the False Claims Act by improperly inflating their bids. Medicare Advantage, also known as Medicare…