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The testimony came as the Trump administration continues to purge inspectors general across sectors of the federal government.   The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) unveiled a four-pronged strategic plan to oversee the nation’s continuing fight against the COVID-19 virus this week,…
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Federal officials have been making efforts to ease restrictions and waive requirements in a time of crisis. The Centers for Medicare & Medicaid Services (CMS) has issued a number of waivers to help healthcare organizations cope with the COVID-19 outbreak. Sorting through them is difficult, because they are heavy in…
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Overzealous and hyper-aggressive audit tactics are scaring providers away from self-governing. The U.S. Department of Health and Human Services (HHS) strikes again, and this time, based on an Office of Inspector General (OIG) audit, Saint Francis Health Center has been asked to refund $5.5 million back to the Medicare contractor. …
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Request is to invoke emergency powers to issue an 1135 disaster and emergency waiver of certain regulations. As updates on the COVID-19 pandemic change day by day, and the number of cases in the U.S. climbs, hospitals are starting to see the effects. In Seattle, it has been reported that…
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Physicians urged to monitor all upcoming developments regarding this new issue. The debate over percutaneous vertebral augmentation is continuing in 2020, with the release of a new local coverage determination (LCD) from Noridian – a Medicare Administrative Contractor (MAC) – and the release of a proposed LCD by another MAC,…
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At issue: hospital overpayments of $54.4 million. There has been recent talk on an online user group that many hospitals have had recoupments of payment for inpatient admissions from 2016 to 2018 due to an “incorrect discharge status code.” This appears to be in response to a November 2019 audit…
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One rule is proposed; the other is now the final rule on price transparency. The Centers for Medicare & Medicaid Services (CMS) recently issued two rules intended to increase the transparency of pricing in the healthcare system, continuing its efforts to provide patients with more data to make informed decisions…
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Many believe this rule will never see the light of day. Among other provisions, the hospital price transparency rule pre-published by the Centers for Medicare & Medicaid Services (CMS) last Friday requires online, a publically accessible publication of “standard charges” that apply to 300 of each hospital’s “shoppable” services. The…
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EDITOR’S NOTE: This RACmonitor series examines a new type of auditing in healthcare – the use of algorithms. In the first article in this series, “Artificial Intelligence is Coming to Medicare Audits – Is Your Legal Team Obsolete?” Mr. Roche reported on statistical sampling being supplanted by more complex methods…
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A preliminary injunction has been filed in federal courts to halt the termination of two dozen Virginia behavioral healthcare providers. There are some updates on the matter of A Village Youth and Family Services, Inc., et al v. The Commonwealth of Virginia et al, through which more than two dozen…
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