CMS continues to help hospitals impacted by the aftermath of Florence No sooner had Monitor Monday signed off on Monday’s program with live reports from the areas ravaged by Florence, then the Centers for Medicare & Medicaid Services (CMS) published a notice that is intended to ease emergency preparedness regulatory…
CMS provides Medicare waivers for providers dealing with natural disasters. I live in North Carolina, and as most of you have seen on the news, we just underwent a natural disaster. Its name is Hurricane Florence. Our Governor has declared a state of emergency, and this declaration is extremely important…
2019 IPPS removes requirement for authentication of admission orders prior to discharge. EDITOR’S NOTE: This is the first installment of a two-part series. When the Centers for Medicare & Medicaid Services (CMS) finalized the 2019 Inpatient Prospective Payment System (IPPS) Final Rule, hospitals across the country breathed a deep sigh…
RAC issue for IRFs has moved from being proposed to being approved. The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex Medical Review for (inpatient rehabilitation facilities) IRFs. The issue: 0A024-Inpatient Rehabilitation Facility (IRF) Stays: Meeting Requirements in the proposed Recovery Audit Contractors (RAC) Topics list…
Once a denial is issued, a P2P will no longer be an option. An astute physician advisor recently brought to my attention a change to the Humana Medicare Advantage peer-to-peer (P2P) process. The announcement (which can be found at this link: https://www.humana.com/provider/support/publications/your-practice-newsletter/peer-review-process-changes) states that effective Aug. 1, a P2P with…
Is CMS preparing to slash payments for procedures with 10- and 90-day global periods? While thousands of doctors have submitted mostly unfavorable comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed evaluation and management (E&M) changes, there are other issues that seem to be receiving much…
Medicare will waive any overpayment if the provider is without fault EDITOR’S NOTE: This is the first in a two-part series as to when facilities should voluntarily refund an overpayment. An often-overlooked provision of the Medicare statute protects providers and suppliers when they are not responsible for a mistake that…
Not enough information in the public use databases to know that a claim is fraudulent. “In God we trust; all others bring data.” That is what the sign above my desk says, right next to my six-foot slide rule. I was pondering the truth behind this tongue-in-cheek saying when I…
If approved, reviews would impact RAC Regions 1 through 4 in all states.In November 2017, the Centers for Medicare & Medicaid Services (CMS) announced that proposed Recovery Auditor (RAC) review topics would be posted. These topics, which have been proposed, but not yet approved, are available on the Medicare Provider…
I have whined in a previous RACmonitor enews article about how the importance given to the admission order in today’s healthcare industry makes absolutely no sense. It’s not an order for a medication or a test, wherein if it is transcribed incorrectly, the patient could be physically harmed. The admission…