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…
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a mystery to many. Sent to hospitals as an Excel workbook, I find it to be data-rich but information-poor.There are 56 pages of explanations, data, and tables. To make it even more frustrating, no one seems to really know who…
Sources tell RACmonitor that Performant, the Recovery Audit Contractor (RAC) for Region 1, has been approved by the Centers for Medicare & Medicaid Services (CMS) to begin recovery auditing activity.  The information came on Friday, March 10 via an email from a Medicare Administrative Contractor (MAC) to a Kentucky facility…