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CORRECTION: Because of a publishing error, this article, written by healthcare attorney David Glaser, was published on May 30 by RACmonitor after the new guidance was actually published. That guidance can be found here, https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO-19-13-Hospital.pdfIn a statement to RACmonitor, Glaser offered comments about the new guidance from the Centers for…
Allegations were made of kickbacks in the form of co-pay waivers. Late last month, US WorldMeds, a pharmaceutical manufacturer, agreed to pay the U.S. Department of Justice (DOJ) $17.5 million  to resolve two whistleblowers’ claims that it violated the False Claims Act (FCA) by paying kickbacks to patients and doctors…
The MAC is proposing an LCD for vertebral augmentation procedures. The controversy over the vertebral augmentation procedures kyphoplasty and vertebroplasty continues with a just-released proposed Local Coverage Determination (LCD) from Noridian, a Medicare Administrative Contractor (MAC). In this LCD, for which comments are now being accepted, Noridian is proposing to…
A search for a national review HWDRG contractor is expected in the third quarter. In a restructuring of the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) jurisdictions, the Centers for Medicare & Medicaid Services (CMS) has created 10 regions across the United States and awarded KEPRO, a BFCC-QIO, a…
A Manhattan Institute senior fellow makes his case for Medicare Advantage. A prominent conservative healthcare policy expert had a simple message in a recent opinion column: before diving into a debate over the prospects of “Medicare for All,” maybe Medicare needs a bit of tinkering first. Manhattan Institute Senior Fellow…
Facilitating appropriate care entails more than coordinating a discharge plan.    Review the literature and you'll find more than 40 definitions of care coordination. In 2007, the Agency for Healthcare Research and Quality (AHRQ), in its landmark paper Closing the Quality Gap, described it as a "deliberate organization of patient care…
The common thread appears to be physicians willing to take money as administrators. As we recently reported, according to Assistant Attorney General Brian A. Benczkowski of the U.S. Justice Department’s Criminal Division, “Philip Esformes orchestrated one of the largest healthcare fraud schemes in U.S. history, defrauding Medicare and Medicaid to…
Outreach to providers on the topic continues. From the same folks who brought you the Electronic Submission of Medical Documentation (esMD), there is a new initiative from the Centers for Medicare & Medicaid Services (CMS) known as the Medicare Fee-for-Service (FFS) Documentation Requirement Lookup Service (DRLS) pilot. Melanie Combs-Dyer, who…