News

Weighting changes will be implemented for the 2019 calendar year. Important changes for the 2019 calendar year in healthcare include Merit-Based Incentive Payment System (MIPS) category weighting changes. The quality category will decrease in importance, with a shift of 5 percent, going from 50 to 45 percent of the overall…
AMA’s changes are complementary to the CMS proposed changes to this code set.  The Centers for Medicare & Medicaid Services (CMS) is moving quickly on its strategies for outpatient office evaluation and management (E&M) services, targeted for implementation in 2021, and the American Medical Association (AMA) is working hard to…
The debate over the controversial two-midnight rule rages on. Ok, I surrender. “This is not the hill I intend to die on” is an accurate metaphor. There has been here at RACmonitor a flurry of concern, debate, troubled investigation, and notice of dodging by health plans, and, as we’ve come…
CHS and Medhost have categorically denied all of the allegations in the complaint. As the use of electronic health records (EHRs) has expanded at a rapid pace, so too has the fraud associated with these systems. An EHR is a digital version, or database, of a patient’s paper charts. The…
New CMS pharmacy dashboards include data sets from 2013 to 2017. The Centers for Medicare & Medicaid Services (CMS) has released its latest “CMS Drug Spending Dashboards.” While the dashboards are interactive (you can look up specific drug data), we took a broader approach and downloaded and analyzed the source…
Part II continues to explain the nuances in the changes made by CMS to its statistical sampling methodology. The Centers for Medicare & Medicaid Services (CMS) recently made significant changes in its statistical sampling methodology for overpayment estimation. Effective Jan. 2, 2019, CMS radically changed its guidance on the use…
The federal watchdog did not, however, decide to demand recoupments. It is said that great minds think alike. And that proved to be true when the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released its report (CMS improperly paid millions of dollars…
Filing focuses on generic drug costs levied by pharmacies absorbed by the pharmacy giant. In 2013, J. Douglas Strauser, a pharmacist, filed a whistleblower lawsuit against Stephen L. LaFrance Holdings Inc. and Walgreens, alleging that they overcharged Medicaid for generic drugs by not giving the government the best price. Stephen…