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The uncomfortable truth about the coronavirus pandemic? A near-total and indefinite shutdown of American life is probably just the beginning.   EDITOR’S NOTE: Veteran RACmonitor and ICD10monitor Editor and Correspondent Mark Spivey has spent the last week with his wife at their home in Monmouth County, New Jersey, working remotely…
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The OIG has instructed MACs to recoup the entire DRG payment on claims dating back to 2016. EDITOR’S NOTE: The RACmonitor special bulletin of Jan. 30, “News Alert: Widespread Recoupments of Incorrect Post-Acute Transfer Claims Have Begun,” is prompting alarm among hospitals, as evidenced by the response from Dr. R.…
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An ad campaign opposing the move is raising eyebrows nationwide. We’re more than halfway into September, but if you’re like me, it feels like 2019 is already over. It doesn’t feel like I’ll have enough time to finish everything I was supposed to before the end of the year. Congress…
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The ruling marks a stinging rebuke of HHS efforts to steer some services from the hospital outpatient setting to physicians. A federal judge has ruled that a Centers for Medicare & Medicaid Services (CMS) final rule slashing Medicare payments for certain hospital outpatient clinical evaluation and management (E&M) services to…
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Adding TKA to the BPCI appears to be more involved than anticipated. As reported by the American Hospital Association and other organizations, starting in 2020, the Centers for Medicare & Medicaid Services (CMS) will be adding outpatient total knee arthroplasty (TKA) to the list of episodes in the Bundled Payment…
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New case law supports due process for Medicare providers. Due process is one of the cornerstones of our society. Due process is the universal guarantee and found in the Fifth Amendment to the United States Constitution, which provides "No person shall…be deprived of life, liberty, or property, without due process…
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The 340B drug pricing program has suffered a major setback. The axe fell on the American Hospital Association (AHA) and on hospitals across the country when the U.S. Court of Appeals dismissed a key AHA lawsuit on Tuesday. Following what can only be called a tempestuous journey, the fight against…
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The 340B drug discount program continues to be in a state of flux The American Hospital Association (AHA) recently filed suit to stop reductions to the 340B drug program. On Dec. 29, 2017, the lawsuit was dismissed by the judge, who ruled: “In conclusion, plaintiffs’ failure to present any concrete…
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The guy either has no idea how the process works or he has mastered the art of lying with statistics. In May 2014, the American Hospital Association (AHA) sued the Secretary of Health and Human Services (HHS) in an attempt to force the government to do something about the ridiculous…
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Two efforts are underway to prevent HHS from cutting Medicare payments to hospitals participating in the 340B drug program. The 340B drug program is under assault, with the latest action coming the from the American Hospital Association (AHA) – which, along with  the Association of American Medical Colleges (AAMC) and…
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