A powerful U.S. Senator is demanding answers regarding the perceived ineffectiveness of Centers for Medicare & Medicaid Services (CMS) efforts to address apparently sizeable overpayments to Medicare Advantage plans. U.S. Sen. Chuck Grassley (R-Iowa) earlier this week sent a letter to newly confirmed CMS Administrator Seema Verma asking pointed questions…
If you’re like me, you had to read through the Skilled Nursing Facility (SNF) Requirements of Participation (ROP) from the Centers for Medicare & Medicaid Services (CMS) a few times to process all the changes. In a document of nearly 200 pages, three columns and small print, sometimes it is…
The first five years of the Recovery Audit Contractor (RAC) audit program created nightmares for many in the provider community. Deadlines were routinely missed at every step of the way. The appeal backlog at the Administrative Law Judge (ALJ) level exceeded three years and does not seem to be getting…
On the next edition of Monitor Mondays, Mary Beth Pace, vice president of care management at Trinity Health, will share how her health system is traversing the new compliance landscape of the MOON: the Medicare Outpatient Observation Notice, which became effective March 8. What are they discovering, and how are…
There is no doubt that state Medicaid Fraud Control Units (MFCUs) have their hands full and are charged with a difficult task. They are responsible for investigating Medicaid fraud. This is part of the responsibility assigned to them by the Centers for Medicare & Medicaid Services (CMS) as a mandate for…
Early warning signs have revealed that the Centers for Medicare & Medicaid Services (CMS) will soon be launching an audit program for compliance with administrative simplification, according to Monitor Mondays special guest Matthew Albright, former director of the CMS Administrative Simplification Group, now vice president of legislative affairs for Zelis…
The Centers for Medicare & Medicaid Services (CMS) will be changing the criteria for short-stay audits in April, according to KePRO, one of the Medicare Quality Improvement Organizations (QIOs), which posted the announcement on its home Web page.“CMS is changing the selection process for medical records for short-stay reviews,” the…
With unusual bipartisan support, a new piece of legislation of about 1,000 pages was signed into law on Dec. 13, 2016 – the 21st Century Cures Act. The Act will allocate about $6 billion to a variety of medically related needs. While the bill has received both applause and criticism…
EDITOR’S NOTE:Matthew Albright will be the special guest on the March 27 edition of Monitor Mondays. Register now!This story was posted on Tuesday in the ICD10monitor e-News. Matthew Albright oversaw the certification program at the Center for Affordable Quality Healthcare (CAQH) and Committee on Operating Rules for Information Exchange (CORE)…
The word “stoned” is a 1960s slang word meaning roughly “intoxicated on illegal drugs.” The United States currently has an opioid epidemic. It has grown quickly, and now is of huge proportions. For the second time in only a few months, two U.S. parents were arrested because police found them…