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All audits are questionable, contends the author, so appeal all audit results. Providers ask me all the time – how will you legally prove that an alleged overpayment is erroneous? When I explain some examples of mistakes that Recovery Audit Contractors (RACs) and other health care auditors make, they ask,…
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OIG report shines spotlight on area of confusion for billing. In a recent report, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced it has determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities.…
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Signed into law on July 2, 1964, the Civil Rights Act was a landmark piece of legislation. Its protections have now been expanded by Congress.  A great deal of news continues to be reported on patterns of workplace sexual harassment across all industries, including entertainment, finance, government, and healthcare. Beyond…
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Costs of outpatient versus inpatient knee replacement a clear area of contention in wake of report.  Last week seemed to be a quiet time on the Medicare regulatory front. Perhaps the three-day government shutdown resulted in things ramping back up, however. For a while I thought I’d have nothing to…
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Two new programs have significant potential in collectively effectuating a meaningful reduction in the appeals backlog. In casting a larger net, the Office of Medicare Hearings and Appeals (OMHA) hopes to engage more providers and suppliers in settlement agreements as it seeks to improve the Medicare claims appeals process by…
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The guy either has no idea how the process works or he has mastered the art of lying with statistics. In May 2014, the American Hospital Association (AHA) sued the Secretary of Health and Human Services (HHS) in an attempt to force the government to do something about the ridiculous…
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The OIG has added specialty drug coverage and reimbursement by Medicaid to its Work Plan.  In October, the OIG added specialty drug coverage and reimbursement by Medicaid to the list of active Work Plan items. This was in addition to the continuing Medicaid-related prescription drug reviews for the 2017 fiscal…
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Two efforts are underway to prevent HHS from cutting Medicare payments to hospitals participating in the 340B drug program. The 340B drug program is under assault, with the latest action coming the from the American Hospital Association (AHA) – which, along with  the Association of American Medical Colleges (AAMC) and…
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A low volume appeals settlement and an expanded Settlement Conference Facilitation process are two initiatives to improve the Medicare claims appeal process. On Friday, the Centers for Medicare & Medicaid Services (CMS) and the Office of Medicare Hearings and Appeals (OMHA) announced two new settlement options for Medicare providers and…
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Tales abound regarding contractors’ errors negatively impacting providers.  If you read my previous article on the audit by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) on billing of services by acute-care hospitals that were provided to patients who were inpatients at another facility,…