News

Five areas of concern are noted by the author. In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk areas providers might expect and why, as Recovery Audit Contractors (RACs) ramp up reviews again. According to Centers for Medicare…
The Low Income Pool or “LIP” is a funding pool designed to support health care providers that provide uncompensated care to Florida residents who are uninsured or underinsured.  There are multiple states with similar programs. CMS approved the LIP in 2005 as part of a section 1115 demonstration project (usually…
We have been reminding inpatient rehabilitation facilities (IRFs), repeatedly of late, and now we’re down to the final two months before the transition away from utilizing Functional Independence Measures (FIMtm) to assign patients to a case-mix group (CMG) and toward using key quality indictor data – specifically, the GG Self-Care…
Case managers could be at risk relative to discharge planning. While not significantly common, hospital case managers have been named in nursing malpractice suits, primarily in association with discharge planning. Attorneys Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. from The Health Law Partners, P.C. discussed this issue and other…
Rules and regulations are always changing. Many readers may remember the Centers for Medicare & Medicaid Services (CMS) Transmittal 534. This was released in early August 2014, and it would have given Medicare contractors the ability to automatically deny associated physician claims when a hospital claim was denied. As written,…
Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2, 2019. In the post, Verma asserted that CMS would require Recovery Audit Contractors (RACs) to “maintain a 95 percent accuracy…
A new five-year partnership between the Boston University School of Public Health and Sharecare is launched. Over the past decade, there has been a data explosion in healthcare, especially for tracking, defining, and addressing the social determinants of health (SDoH). This has included the following: Predictive analytics to prioritize Medicaid…
Author finds fault with WPS policy. You might think that you could rely on the accuracy of a Medicare Administrative Contractor (MAC) policy, but apparently, you can’t.  First, I’d like to extend thanks to my colleague Sharon for sending me WPS’s deeply flawed split/shared evaluation and management (E&M) policy. If…