The MAC is proposing an LCD for vertebral augmentation procedures. The controversy over the vertebral augmentation procedures kyphoplasty and vertebroplasty continues with a just-released proposed Local Coverage Determination (LCD) from Noridian, a Medicare Administrative Contractor (MAC). In this LCD, for which comments are now being accepted, Noridian is proposing to…
Outreach to providers on the topic continues. From the same folks who brought you the Electronic Submission of Medical Documentation (esMD), there is a new initiative from the Centers for Medicare & Medicaid Services (CMS) known as the Medicare Fee-for-Service (FFS) Documentation Requirement Lookup Service (DRLS) pilot. Melanie Combs-Dyer, who…
A search for a national review HWDRG contractor is expected in the third quarter. In a restructuring of the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) jurisdictions, the Centers for Medicare & Medicaid Services (CMS) has created 10 regions across the United States and awarded KEPRO, a BFCC-QIO, a…
Adding TKA to the BPCI appears to be more involved than anticipated. As reported by the American Hospital Association and other organizations, starting in 2020, the Centers for Medicare & Medicaid Services (CMS) will be adding outpatient total knee arthroplasty (TKA) to the list of episodes in the Bundled Payment…
Last week the Centers for Medicare & Medicaid Services (CMS) released a blog post from agency Administrator Seema Verma titled “Recovery Audits: Improvements to Protect Taxpayer Dollars and put Patients over Paperwork.” In the post, Ms. Verma talked about the Recovery Audit Contractor (RAC) changes CMS made back in 2015,…
Let’s talk targeted probe-and-educate (TPE) audits. TPE audits have turned out to be “wolf audits” in sheep’s clothing. The Centers for Medicare & Medicaid Services (CMS) asserted that the intent of TPE audits is to reduce provider burden and appeals by combining medical review with provider education. But the “education”…
Verma acknowledges lingering gripes about the RACs, pledges to do better. In touting the federal government’s efforts to make the realities of dealing with Recovery Audit Contractors (RACs) more palatable for providers across the country, one of the nation’s top health officials apparently couldn’t help but take a swing at…
Prices of certain drugs continue to spiral out of control as alternatives are sought. ol·i·gop·o·ly (äləˈɡäpəlē), noun: a state of limited competition, in which a market is shared by a small number of producers or sellers. I have been looking at data from the Centers for Medicare & Medicaid Services…
There are winners and losers in the recently posted proposed rule. Weighing in at 1,824 pages, the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year had something for everyone – and, in some cases, nothing at all. To the latter point, there’s no doubt that Ronald…
CMS pledging improved healthcare quality and expanded access for patients. The release of the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year came with a bit of branding. “Rethinking Rural Health” and “Unleashing Innovations” were the two catchy slogans unveiled by the Centers for Medicare &…