April 19, 2021
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
CMS Extends PHE for Another 90 Days
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…
April 15, 2021
By Robin Sewell, CDIP, CCS, CPC, CIC
OIG Report: Query Aggressive CDI Practices?
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…
April 15, 2021
By Knicole C. Emanuel Esq.
The ALJ Backlog Dissolves – and SMRC Audits Escalate
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.…
April 15, 2021
By Ronald Hirsch, MD
News Alert: BFCC-QIO Audits Poised to Resume
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…
April 1, 2021
By Knicole C. Emanuel Esq.
Medicare Auditors Fail to Follow the Jimmo Settlement
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…
March 18, 2021
By Knicole C. Emanuel Esq.
Beware the Ides of March – And Medicare Provider Audits
“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…
March 4, 2021
By Knicole C. Emanuel Esq.
Expect More Medical Record Audits Under Biden
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…
February 11, 2021
By Michael Calahan, PA, MBA, AHIMA-Approved ICD-10 CM/PCS Trainer
Federal Audit Findings for Medical Device Credits
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…
February 3, 2021
By Edward Roche, PhD, JD
Should There be a National Standard for Certification of Auditors?
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,…
January 14, 2021
By Knicole C. Emanuel Esq.
Medicaid Suspension Lifted Due to Lack of Evidence of Intent
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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Adam J. KleinAllen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAmber Soucy, MSN, RNAndrew B. Wachler, Esq.Andrew B. Wachler, Esq. and Emma E. TrivaxAndrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler, Esq. and Kaitlin Nucci, Esq.Andrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTAspen AlbrightBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBenjamin Kartchner MD, CHCQM-PhyAdvBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckClark AnthonyColleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RNDaniel Zirkman, MDDavid A. McKenzie, CAEDavid Jury MD, MSDavid M. Glaser, Esq.Delilah Davis, RN, BSN, CCADenise Coleman, LPNDenise Nash, MD, CCS, CIMDheeraj Mahajan, MD, FACPDuane Abbey, PhD, CFPEdward Hu, MD and Charles Locke, MDEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVEllen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPEllen Parucka Walker LCSW ACSWErica E. Remer, MD, CCDSErin Diesel Roumayah, Esq.Frank D. Cohen, MPA, MBBGlenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAMGloryanne Bryant, RHIA, RHIT, CCS, CCDSGreg FordHolly Louie, RN, BSN, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John Foggle, MDJohn K. Hall, MD, JD, MBA, FCLM, FRCPCJulia K. Brodt, PhDJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKaitlin Nucci Esq.Kathleen K. Borchard, BSN, RN-ACMKathy Seward, MD, CHCQM-PHYADVKim T. Charland, BA, RHIT, CCSKnicole C. Emanuel Esq.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerLaurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS TrainerLeslie Marsh, RN, BS, MSN, MBALori O’Hara, MA, CCC-SLPMadison AllenMaggie Elehwany, JDMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Anne Hayes Hartman, Esq.Mary Inman, Esq. and Max Voldman, Esq.Matt Lambert, MDMatthew AlbrightMaureen Testoni Esq,Max Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael KennedyMichael Rosen, Esq.Nancy J. Beckley, MB, MBA, CHCNena Scott, MSEd, RHIA, CCS, CCS-P, CCDSPhillip Angello, MDRalph Wuebker, MD, MBARichard “Dick” Beckley, YNS, USN, 1966-1970Robin Sewell, CDIP, CCS, CPC, CICRonald Hirsch, MDSarah Hillegonds, Esq.Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-PSean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC and David Glaser, Esq.Shannon Deconda, CPC, CPC-I, CEMC, CMSCS, CPMA®Stanley Nachimson, MSStefani Daniels, MSN, RN, CMAC, ACM and Tiffany Ferguson, LMSW, ACMStefani Daniels, MSNA, ACM, CMAC
