Balancing patient advocacy with access to Part A Medicare skilled nursing benefit. The ambiguities of Medicare regulations often create conundrums for case managers and physician advisors as we try to advocate for our patients while remaining compliant. One area that often creates a dilemma in balancing patient advocacy with compliance…
Decision expected soon in the Providence lawsuit. As regular Monitor Monday listeners know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA), alleging a conspiracy between Providence and JATA to upcode…
The controversy continues over hospitals denied authorization to transfer patients to LTACHs. It is my long-held opinion that health insurance companies exist to not pay claims. They are an investment tool for the investment class. The plutocracy has never acted in its own long-term best interests. In few places is…
CMS also has updated its therapy manuals, making elimination of FLR official. Many therapy providers, at hospital outpatient departments and private-practice clinics alike, were reluctant to stop submitting functional limitation reporting codes and impairment modifiers until they could see the guidance clearly written in black and white in the associated…
Weighing the difficult decisions being made in the business of healthcare. Medicine has commonly been considered one of the most altruistic professions.  From long years spent in training to long hours spent caring for others and the perpetual drive to heal those who are hurt and comfort those who are…
CMS squeaks by with B-plus in OIG audit. If the Centers for Medicare & Medicaid Services (CMS) received a grade for its audit performance during the 2015 and 2016 fiscal years, it would have been about a B-plus, maybe waived up to an A-minus, according to an announcement made recently…
MAC to audit physicians who prescribe opioids. It is well-known to the medical community and to the general public that the opioid epidemic has taken too many lives. The causes are myriad (I outlined these in a KevinMD.com article in 2016, the second most-read article of the year on that…
“Non-essential” services are healthcare data services upon which providers come to rely. EDITOR’S NOTE: A second government shutdown remains a possibility if a group of bipartisan lawmakers fails to reach an agreement by Feb. 15 on a border security funding package that would avoid a veto from President Trump. Here…
Controversy Swirls: Payers vs Providers EDITOR’S NOTE: Attorney David Glaser reported this story live on Monitor Monday today. That statement may appear to be somewhat controversial, but it shouldn’t be. First, plans are required to provide the patient with benefits that are at least as generous as those required under…
Expect more changes to come for provider-based clinics. There has been much federal oversight activity regarding provider-based clinics of late. For those of you that have such clinics and/or are anticipating the development of such clinics, study the rules, regulations, and pronouncements of the Centers for Medicare & Medicaid Services…