Maintaining records and accurately billing cannot be passed onto a third party like a billing company. Jamestown Regional Medical Center in Tennessee is in big trouble. Medicare and Medicaid were expected to cut off payments to the hospital Wednesday, with the agencies noting that the hospital currently does not meet…
Emergency departments (EDs) have been a hot-button topic in the battles over “surprise” billing.  Certainly, many patients use EDs inappropriately. We’ve all read and heard about uninsured patients, patients with no primary care provider, patients who simply abuse the fact that EDs are always open, patients with complaints that are…
Federal entities are beginning to pay closer attention to hospitals’ financial wellness. Last week was Revenue Integrity Week, which marked an opportunity to acknowledge the work of the many people in health systems’ hospitals who help get a claim paid. I am always amazed that they can take our often-illegible…
The most recent case involved a Zone Program Integrity Contractor (ZPIC), which turned a $4,000 overpayment into a $3 million overpayment using extrapolation. EDITOR’S NOTE: This is the second in a series of reports on alleged bias the author has uncovered in extrapolation audits. I recently wrote an article opining…
The OIG has added specialty drug coverage and reimbursement by Medicaid to its Work Plan.  In October, the OIG added specialty drug coverage and reimbursement by Medicaid to the list of active Work Plan items. This was in addition to the continuing Medicaid-related prescription drug reviews for the 2017 fiscal…