News

In January CMS posted two new questions and answers on its FAQ Web site: numbers 9973 and 9974. Both of these relate to hospital outpatient observation services, which has been a problem area for two decades.
Clinical and administrative staff at many organizations are struggling with the issue of what "medically necessary" really means - even those who have reviewed the Medicare Benefit Policy Manual (MBPM), Chapter 8, section 20.1 Three-Day Prior Hospitalization; the chapter can be viewed or downloaded here. The following paragraph in that…
U.S. ambulance providers generated about $9 billion in revenue in 2009, according to information gathered by Hoover's, Inc., which offers proprietary business information through the Internet and other online services. Of that amount, hospital-based ambulance services commanded a 9 percent market share. Not surprisingly, given the Medicare program's complex billing…
Little did I know when I e-mailed one of the authors of a Feb. 3 article in RACMonitor (Is It Worth the Effort to Rebut RAC Findings: 10 Steps for a RAC Discussion) that my comment would turn into a discussion and now an article of my own on the…
Now that the RAC audits are in full swing, providers may be wrestling to understand the new discussion period and the implications for choosing to exercise this new option and when they should actually consider initiating a discussion period.
Medically unnecessary services topped the list of claim errors in the latest comprehensive error rate testing (CERT) report compiled in November 2009 and released last month by the Centers for Medicare & Medicaid Services (http://www.cms.hhs.gov/CERT/). The report covers the Medicare fee-for-service (FFS) program, and reviews are conducted of claims submitted…
By Chuck Buck and Dennis JonesContributing editor Dennis Jones certainly felt as if he was on the other end of the query process when providers were querying him during Monitor Monday's podcast earlier this week.
There is something about Florida in February, our sunny State just wrapped up Super Bowl XXXXIV as the Saints Came Marching In, Jamie McMurray took the checkered flag at the Valentine's Day Daytona 500, the official Strawberry Festival is imminent, thousands of Harley riders are rolling into Daytona Beach for…