Providers urged to review potentially eligible claims and consider participation in the expanded SCF process. The Office of Medicare Hearings and Appeals (OMHA) publicly implemented the long-awaited expansion to its Settlement Conference Facilitation (SCF) process on June 15. SCF is an alternative dispute resolution process that provides appellants and the…
The whistleblower brought this suit under the federal False Claims Act. In February 2014, whistleblower Sarah Benhke, the former senior Medicare Part D actuary at Aetna, filed a sealed complaint against CVS Caremark, the pharmacy benefit management department of healthcare giant CVS Health, accusing the company of billing Medicare Part…
Federal entities are beginning to pay closer attention to hospitals’ financial wellness. Last week was Revenue Integrity Week, which marked an opportunity to acknowledge the work of the many people in health systems’ hospitals who help get a claim paid. I am always amazed that they can take our often-illegible…
CMS unveils new rural healthcare strategy via telehealth. The Centers for Medicare & Medicaid Services (CMS) wants to reduce hospital readmissions and unnecessary ER visits with its newly unveiled Rural Health Strategy. Currently, there are significant barriers to accessing telehealth. While physicians and providers have to answer to their respective…
 Questions still linger regarding specifics of implementation. The Centers for Medicare & Medicaid Services (CMS) has unveiled a new Medicaid and Children’s Health Insurance Program (CHIP) “Scorecard,” described by the federal agency as “a central component of the Administration’s commitment to modernize the Medicaid and CHIP program through greater transparency…
CMS intends to target home health agencies in five states. It looks like the Centers for Medicare & Medicaid Services (CMS) is going to be targeting home health agencies in several states with another attempt to reduce fraud. Last week the agency announced that it is going to start another…
OMHA also announced that the SCF expansion will include a “fast track” process, or “SCF Express.” The Office of Medicare Hearings and Appeals (OMHA) hosted a Medicare Learning Network (MLN) conference call to release details regarding the long-awaited expansion to the Settlement Conference Facilitation (SCF) program on May 22, 2018.…
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…
Improper use of extrapolation statistics is stunningly egregious, according to the author. Over the years, I have written extensively about the statistical extrapolations that are a large part of the audit process. In general, auditors—both government and private—make use of the extrapolation to significantly increase the overpayment estimates imposed on…
The author responds to comments from readers of his recent RACmonitor article. The May 17, 2018 RACmonitor news article Two-midnight Rule Remains Confusing; Total Knee Replacements Frustrating to Many resulted in several comments before I had even finished my first cup of coffee. Chuck Buck, RACmonitor editor and host of…