Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2, 2019. In the post, Verma asserted that CMS would require Recovery Audit Contractors (RACs) to “maintain a 95 percent accuracy…
A new five-year partnership between the Boston University School of Public Health and Sharecare is launched. Over the past decade, there has been a data explosion in healthcare, especially for tracking, defining, and addressing the social determinants of health (SDoH). This has included the following: Predictive analytics to prioritize Medicaid…
President Trump issues an executive order on kidney disease and a new payment model for radiation therapy. As reported by Dr. Ronald Hirsch on the RACmonitor.com Monitor Mondays webcast, last week the president issued an executive order on kidney disease. The executive order was touted by many in the medical…
Coverage would include those suffering from chronic lower back pain who are also enrolled in approved studies. The Centers for Medicare & Medicaid Services (CMS) is proposing to cover acupuncture for Medicare patients who suffer from chronic lower back pain and are also enrolled participants in certain clinical trials –…
Swing vote by Chief Justice John Roberts reflects his support of judicial precedent. On June 26 the U.S. Supreme Court issued a decision (https://www.supremecourt.gov/opinions/18pdf/18-15_9p6b.pdf)  on how courts should handle ambiguous government regulations.  Many people, including me, expected that the case would change the level of deference courts grant to a…
OMHA’s new eligibility requirements are intended to benefit more providers. The Office of Medicare Hearings and Appeals (OMHA) has expanded its Settlement Conference Facilitation (SCF) program, and it is now open to the appellant community. By way of background, Settlement Conference Facilitation (SCF) is an alternative dispute resolution process designed…
This case of goes beyond DSH payments. Earlier this month the U.S. Supreme Court decided an appeal brought by Allina and many other hospitals challenging the methodology the government used when calculating disproportionate share payments. But even if this sounds irrelevant, don’t stop reading, because this decision will have an…
Trump’s Executive Order will include a requirement to disclose contracted rates. U.S. Health and Human Services (HHS) Secretary Azar and White House officials held a meeting this morning to explain an executive order that the President plans on releasing today on healthcare price transparency.   Officials said that the executive…
Recent report from HHH/OIG faults CMS. A recent study by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) revealed a concerning series of findings related to the under-reporting of instances of potential abuse and/or neglect of elderly Medicare patients. Every year, tens of thousands…
CMS agrees to settle appeals for IRF facilities following a two-year disputed with the industry. The Centers for Medicare & Medicaid Services (CMS) has announced voluntary settlement options for inpatient rehabilitation facility (IRF) providers with claims that have not yet exhausted the Qualified Independent Contractor (QIC), Office of Medicare Hearings…