News

Never ignore a request for records by the single-state agency in your state. One of the best examples that illustrates the importance of the “single state agency” involves a Medicaid fraud scheme in Illinois involving four women. It’s a real-life Bonnie and Clyde – if Bonnie and Clyde stole healthcare…
MSPB could be the “new normal” for length of stay. We have all gotten to hear that phrase – a “new normal” – over the past 6-9 months, as we have dealt with the COVID-19 pandemic, and as tough as it is to admit, it is probably real. But maybe…
The new rule mandates that hospitals disclose their prices. Most providers already know that effective Jan. 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is requiring that hospitals nationwide post all of their negotiated third-party rates in a machine-readable file on their website, and without barriers. Additionally, CMS…
With an expected ramp-up in audits and denials for care across all healthcare services in the coming months, we continue to hear questions related to how Medicare views “medical necessity” for an inpatient rehabilitation facility (IRF) stay. And we continue see issues arise over an acute, biased definition of “medical…
Coding must be supported by documentation, but also by the Official Coding Guidelines. While preparing for a clinical validation presentation on acute kidney injury denials, I took inventory of the most common denials and recoveries obtained by payers. It came as no surprise that sepsis, severe malnutrition, and encephalopathy were…
Expect more reporting on the coronavirus. We here at the Monitors – RACmonitor, ICD10monitor, Monitor Mondays, and Talk Ten Tuesdays – continue to report on COVID-19, the disease caused by the coronavirus, which has claimed the lives of more than 210,000 and has infected more than 7.5 million here in…
New rule appears to be fraught with problems and challenges. In a provision glossed over by most, the 2021 Inpatient Prospective Payment System (IPPS) Final Rule introduced a requirement that all providers transmit all records to Quality Improvement Organizations (QIOs) via electronic means as of Oct. 1, 2020. As a…
Flurry of activity confronts legislators amid the pandemic. It’s been quite a week in D.C. First, I’m going to touch on just four events that happened in Washington that impact the healthcare industry:   Good news first: the president signed a continuing resolution last Wednesday that will keep the federal…