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CMS also suspended Medicare’s FFS claims payment adjustment through December. The Centers for Medicare & Medicaid Services (CMS) announced that the suspended sequestration payment adjustment of 2 percent –  which applied to all Medicare Fee-for-Service (FFS) claims from May 1 through Dec. 31, 2020, later extended through March 21, 2021…
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Aggressive CDI practices may account for at least some of their findings.  The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) wrapped up its investigation into hospital upcoding in February. My first thought when I read the associated proposed plan turned to aggressive clinical documentation…
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The long-running backlog at the ALJ may soon be a non-issue. The administrative law judge (ALJ) backlog will soon be no more. Yes, the 4-6-year waiting period between the second and third level of medical appeals will be back to 90 days, within the statutory requirement, by sometime this year.…
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Providers would do well to prepare by taking a close look at their short stays. After a multi-year pause due to the COVID-19 pandemic and a contract dispute, it appears that the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) short-stay audits are poised to resume, with Livanta being the…
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Some Uniform Program Integrity Contractors (UPICs) have failed to follow the Jimmo settlement standard. Auditors are not lawyers. Some auditors do not even possess the clinical background of the services they are auditing. I’m concentrating on the lack of legal licenses today. Because the standards to which auditors need to…
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“Beware the Ides of March,” the soothsayer in Shakespeare’s “Julius Caesar” warned, foretelling the titular character’s doom. The Ides may now be behind us, but there are plenty of audits to come – and they’re no less ominous. As such, today I am going to cover the state of healthcare…
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More covered health services and more policing under the Biden administration. President Biden’s healthcare policies differ starkly from those of former President Trump’s, and I will discuss some of the key differences in this article. Biden is already sending a clear message to healthcare providers: his agenda includes expanding government-run…
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There are five critical mistakes made by providers. By now, healthcare providers that perform “device-dependent” or “device-intensive” procedures know the follow-up steps necessary in reporting vendor or manufacturer warranty credits for replacement devices or free-of-charge initially placed devices. When credits received are equal to or exceed 50 percent of the…
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Certify the certifiers. Have you ever been in a Medicare hearing and realized the person testifying for the auditor does not understand what they are talking about? Recently, I was in such a hearing. A number of claims filed by my client had been rejected because of poor documentation. Now,…
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Happy 2021! I have great news to share. I’m fairly sure that everyone reading is educated about what a preliminary injunction is, and how important it can be for a healthcare provider falsely accused of fraud to lift the mandatory suspension of reimbursement. Over the holidays, a judge found that…
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