News

Does underbilling equate to overbilling? Not exactly. A Monitor Monday listener recently asked, “is it true that underbilling is just as bad as overbilling? Can you be accused of fraud when you make a mistake that saves the government money?”  This question comes up somewhat frequently, in part because people…
Recent report from HHH/OIG faults CMS. A recent study by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) revealed a concerning series of findings related to the under-reporting of instances of potential abuse and/or neglect of elderly Medicare patients. Every year, tens of thousands…
Insys founder found guilty of racketeering in connection with bribes to prescribe potent opioid spray. On past Monitor Monday programs, we have reported on John Kapoor, the former CEO of opioid giant Insys Therapeutics Inc., who has been under indictment since October 2018 for alleged violations of the Anti-Kickback Statute…
CMS agrees to settle appeals for IRF facilities following a two-year disputed with the industry. The Centers for Medicare & Medicaid Services (CMS) has announced voluntary settlement options for inpatient rehabilitation facility (IRF) providers with claims that have not yet exhausted the Qualified Independent Contractor (QIC), Office of Medicare Hearings…
Two nearby rural facilities with the same owner remain open amid the crisis. A troubled rural Tennessee hospital has been forced to close. As reported by RACmonitor Thursday, local reports today indicate that Jamestown Regional Medical Center in northern Tennessee had its doors locked as of Thursday evening, with a…
Ensuring your documentation meets medical necessity standards In 2003, the Centers for Medicare & Medicaid Services (CMS) made a change within the Claims Processing Manual regarding the selection of the evaluation and management (E&M) level of service to be effective in 2004. This change made the need, reason, or extensiveness…
A regulation states you may not appeal a decision by a contractor. During a recent Monitor Monday broadcast, a listener questioned whether it is permissible to challenge the decision to reopen a claim during an audit. The listener’s question is an astute one that hearkens back to a troubling case…
Maintaining records and accurately billing cannot be passed onto a third party like a billing company. Jamestown Regional Medical Center in Tennessee is in big trouble. Medicare and Medicaid were expected to cut off payments to the hospital Wednesday, with the agencies noting that the hospital currently does not meet…