New RAC targets are being proposed by CMS as the agency seeks to consolidate Medicare audits. You have to stay on your toes when you deal with Recovery Audit Contractors (RAC) audits— not to mention all the other types of regulatory audits that health care providers undergo. This article investigates…
New Z codes also aimed at reducing hospital readmissions. The one thing that medicine does not have enough of is abbreviations. So allow me to introduce the RACmonitor to another one: SDoH. I am sure many of you are aware of the social determinants of health (SdoH), but for those…
Two CMS initiatives continue to cause confusion among healthcare providers EDITOR’S NOTE: The following is a summary of a broadcast segment on Monitor Monday, May 14 by the author. Do you realize that the two-midnight rule has been the law of the land for the last four years, seven months…
Most compliance decisions involve balancing risk. EDITOR’S NOTE: The following is a summary of a recent broadcast segment on Monitor Monday by the author. Generally speaking, people do a terrible job evaluating risk. Let’s look at a real-world example. There have been some recent accidents involving automated vehicles, including one…
The author provides a long-term care provider’s perspective on TKA patients. While reading Dr. Juliet Ugarte Hopkin’s recent article on criteria for skilled post-acute care for total knee arthroplasty (TKA) patients, my brain went into claim defense mode. As a post-acute rehabilitation director I was tasked with ensuring our patients…
Recoupment and one-day inpatient admission for total knee replacement. EDITOR’S NOTE: The following is a summary of a broadcast segment on Monitor Monday, May 7 by the author. While we are still trying to make sense of what the Centers for Medicare & Medicaid Services (CMS) meant with its proposal…
HRSA claims delay will have no impact on current stakeholders. The Health Resources and Services Administration (HRSA), which administers Section 340B of the Public Health Service Act, has published a proposal to delay for another year the ceiling price and civil monetary penalties regulation that was originally issued by the…
The scoring mechanisms of the MDM are suggested tools, not rules or laws. In our last article we explored how time in conjunction with medical decision-making (MDM) must support the same level of service, and why that rule makes sense. However, we were left with a puzzling consideration in regard…
Level of care is increasingly becoming a source of payer utilization review denials It was widely recognized after the Centers for Medicare & Medicaid Services (CMS) adopted meaningful use and the widespread transition to electronic medical records (EMR) that EMR transition affected billing by hospitals. For payers that have per…
Those involved in compliance will want to keep tabs on these changes with due concern. The Bipartisan Budget Act of 2018 (BiBA) was signed into law on Feb. 9, 2018. As is typical with these budget bills, there are more than 2,000 pages, including a hodgepodge of issues involving healthcare.…