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Physicians in general are not trained to think this way, but may be forced to do so in the very near future. During the early part of this month, the U.S. has been averaging nearly 200,000 new cases each day, a 15-percent increase from the average two weeks prior. Whether…
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Now more than ever it’s no time to cut corners. EDITOR’S NOTE: This article is an expansion of the original piece, “CoP Compliance in the Face of COVID-19: No Time to Cut Corners,” originally published April 1, 2020. Recent articles by Marie Stinebuck, Edward Hu, MD, and Stefani Daniels touch…
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Hospital medical records are under scrutiny by the Centers for Medicare & Medicaid Services.  Via two unrelated changes, the Centers for Medicare & Medicaid Services (CMS) is targeting the hospital medical record for added scrutiny. It is clear that caring for patients during the COVID-19 pandemic costs more than during…
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While the introduction of new COVID-19 reimbursement rules and regulations have brought on their share of confusion, there is one certainty healthcare organizations can bank on: oversight of incentive dollars will be a regulatory priority. In fact, federal watchdogs are not wasting any time, as reports suggest monitoring of billing…
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Homelessness continues to be a compliance issue. Homelessness is a population health crisis. Doing nothing is not an option. Hospitals following existing law and best practices in population health management, within the confines of limits on resources, can make a difference. To truly address homelessness will require political will, as…
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CMS offers advice through its Medicare Learning Network Connects bulletin to avoid coding errors. Mistakes happen, and errors do occur in the coding industry. The May 24 Centers for Medicare and Medicaid Services (CMS) Medicare Learning Network (MLN) Connects bulletin included provider compliance information that is noteworthy and important to…
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Most compliance decisions involve balancing risk. EDITOR’S NOTE: The following is a summary of a recent broadcast segment on Monitor Monday by the author. Generally speaking, people do a terrible job evaluating risk. Let’s look at a real-world example. There have been some recent accidents involving automated vehicles, including one…
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The whole world of opt-out physicians and practitioners creates compliance issues, particularly for coding, billing, and reimbursement Physicians and certain practitioners can elect to opt out of the Medicare program. An affidavit must be filed with a Medicare Administrative Contractor (MAC) first. There is then a two-year process, with the…
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Testing for compliance with the CMS-13 list of diagnostic categories can be down through presumptive methodology or medical review.
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New policy changes from DOJ will impact False Claims Act cases moving forward. In announcing a significant policy change, the U.S. Department of Justice (DOJ) said that when it concludes that a qui tam case lacks merit, it will file a motion to dismiss the case rather than allowing the…