News

Federal regulation is causing headaches for providers performing home sleep studies. I often comment that I learn a new rule every week and that my clients constantly teach me new things. This story combines those two truths.  A client taught me about a rule you need to know if your…
The allegations in the case focused on CCs and MCCs. EDITOR’S NOTE: This story appeared Aug. 20, 2019, in the ICD10monitor news. A Texas federal judge recently dismissed a False Claims Act lawsuit alleging that Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims. The whistleblower lawsuit, filed…
The CMS Administrator could have chosen a better example to highlight plans for lower costs during recent remarks. With the release of the 2020 Inpatient Prospective Payment System (IPPS) Final Rule and the 2020 Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule rules, Centers for Medicare & Medicaid…
Changes are effective Oct. 1, 2019 In this article, we aim to continue to remind Inpatient Rehabilitation Facilities (IRFs) of the looming transition from utilizing Functional Independence Measures (FIMtm) for the purposes of assigning patients to a case-mix group (CMG) to the use of key quality indictor data – specifically…
Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted;…
Understanding how each physician’s specialty is properly registered. As you might know, one of my primary projects is predicting the likelihood that a particular provider may be audited – and if so, which procedures, codes, and/or modifiers are most at risk. To a large degree, this type of target acquisition…
The case continues even after two suicides. When does an audit go beyond the reasonable and become persecution? An act of tyranny by claim denial and extrapolation? Vernon Partners LLC (name changed for reasons of confidentiality), a medical provider in Florida, provides durable medical equipment (DME) services and counseling to…
Confusion abounds, but compliance is required. The Centers for Medicare & Medicaid Services (CMS) has entered into the fray of transparent hospital pricing in a very big way.  The new OPPS (Outpatient Prospective Payment System) rule appeared in examination format (i.e., unofficial format) in the July 29 edition of the…