News

CMS launches healthcare outcomes challenge. Expect more artificial intelligence (AI) in healthcare in 2020. We will see AI used primarily in diagnostics and auditing. In each of these areas, AI promises to impose drastic changes on society. As these changes reverberate through organizations, old work patterns will be disrupted. In…
The OIG has instructed MACs to recoup the entire DRG payment on claims dating back to 2016. EDITOR’S NOTE: The RACmonitor special bulletin of Jan. 30, “News Alert: Widespread Recoupments of Incorrect Post-Acute Transfer Claims Have Begun,” is prompting alarm among hospitals, as evidenced by the response from Dr. R.…
At issue: hospital overpayments of $54.4 million. There has been recent talk on an online user group that many hospitals have had recoupments of payment for inpatient admissions from 2016 to 2018 due to an “incorrect discharge status code.” This appears to be in response to a November 2019 audit…
The audit environment is unlikely to improve. On Monday, Jan. 14, the Monitor Mondays panel of experts came together to celebrate the 10th anniversary of the launch of the weekly broadcast, and we provided our listeners with some perspective on what to expect in the coming year. The following is…
Physicians urged to monitor all upcoming developments regarding this new issue. The debate over percutaneous vertebral augmentation is continuing in 2020, with the release of a new local coverage determination (LCD) from Noridian – a Medicare Administrative Contractor (MAC) – and the release of a proposed LCD by another MAC,…
New white paper addresses behavioral healthcare in the ED and the SDoMH The social determinants of health (SDoH) are on everyone’s watch list, but attention must also go to the social determinants of mental health (SDoMH). The costs incurred to treat behavioral health and substance abuse in emergency departments are…
Often overlooked is the line-item price reduction step, particularly related to partial or 50 percent-or-greater credits. It was inevitable: just when hospitals were getting comfortable with their policies and procedures for reporting implantable medical device credits, even to the point of congratulatory back-slaps for meticulously following all related compliance steps,…
The absence of a physician’s signature should not result in denial of a Medicare claim. As a regulatory and compliance officer, I often have the privilege of working with some of the best and most respected attorneys in the industry, and Monday, during Monitor Mondays, was no exception. Attorney David…