September 3, 2020

The Audit Algorithm Arms Race in Medicare

By Edward Roche, PhD, JD
Providers forced to camouflage in mediocrity.  EDITOR’S NOTE: This the first in a series of articles that explores the use of algorithms in the auditing of medical claims. The Centers for Medicare & Medicaid Services (CMS) has pioneered the use of computer algorithms for detection of fraud. These efforts leverage technologies…
September 3, 2020

Continuing Confusion Clouds CS Compliance

By Chuck Buck
During this week’s Monitor Mondays broadcast, Ronald Hirsch, MD, vice president at R1 RCM, reminded listeners how confusing all the waivers and flexibilities associated with the COVID-19 pandemic have been, while noting that what is more amazing is that the confusion hasn’t stopped. The latest confusion, Hirsch said, relates to…
September 3, 2020

Telehealth and Medicaid Expansion during COVID

By Knicole C. Emanuel Esq.
This article will explore Medicaid expansion during COVID-19. We all know that COVID has uprooted our lives. Telehealth is the new post-COVID norm, whereas it was in infancy pre-COVID. Perhaps the pandemic has spurred on Medicaid expansion as well. I would be remiss if I did not mention that increased…
September 3, 2020

Health Literacy, COVID, and the SDoH  

By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
Over the course of the continuing COVID-19 pandemic, one topic has mysteriously fallen under the radar. It’s something that greatly impacts health outcomes, and especially virus transmission rates. The Joint Commission identified this issue in 2008 as among the most important factors to impact population health. Any ideas? One final…
August 31, 2020

News Alert: CMS to Require Positive COVID-19 Test Results for 20-Percent Medicare Add-on Payment

EDITOR’S NOTE: This article, originally published on RACmonitor and ICD10monitor, has been updated to alert facilities that COVID-19 testing inclusions will have a fiscal impact starting Sept. 1, 2020. Effective Sept. 1, the Centers for Medicare & Medicaid Services (CMS) has enlisted a mandate requiring hospitals to have positive COVID-19…
The CARES Act included provisions mandating reporting of test results. Federal officials announced a set of sweeping regulatory changes for nursing homes nationwide this week, an expected move considering the disproportionate impact the continuing COVID-19 pandemic has had on such facilities since its onset earlier this year. The Centers for…
August 27, 2020

Feds of a Feather Investigate Together

By David M. Glaser, Esq.
Much like episodes of Law & Order, news stories often provide the ideas for my articles. Events off the East Coast last week offered a quick reminder about the importance of recognizing the significance of contacts with certain government investigators.  Last week, former presidential advisor Steve Bannon was arrested on…
The Democrats held their national convention last week, and this week the Republicans follow suit. To help see the forest for the trees for these two weeks, here’s a quick summary of where both President Donald Trump and Joe Biden stand on healthcare policy.  We’ll start off easy: the Patient…