By
Each year the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases its annual Medicaid Fraud Compliance Performance Report. There is much to learn from this compendium of information provided by 50 Medicaid Fraud Control Units (MFCUs), and this article will highlight some of…
By
After more than 18 months of planning by the Centers for Medicare & Medicaid Services (CMS) and a mad scramble by hospitals in response to last-minute guidance, the Medicare Outpatient Observation Notice (MOON) is now the law of the land, and has been since it became effective March 8, 2017.…
By
It has been a busy two weeks. Ten days ago, the Centers for Medicare & Medicaid Services (CMS) released the proposed 2018 Inpatient Prospective Payment System (IPPS) rule, which, as usual, came out late on a Friday afternoon. The good news about the Rule is that the agency did not…
By
When it comes to Medicaid providers in the State of New Mexico, providers looking for relief from auditors looking to recoup dollars can count on no help from the state. This is due to a recent bill that Republican Governor Susana Martinez declined to sign into law that would provide…
By
On the next edition of Monitor Mondays, Mary Beth Pace, vice president of care management at Trinity Health, will share how her health system is traversing the new compliance landscape of the MOON: the Medicare Outpatient Observation Notice, which became effective March 8. What are they discovering, and how are…
By
There is no doubt that state Medicaid Fraud Control Units (MFCUs) have their hands full and are charged with a difficult task. They are responsible for investigating Medicaid fraud. This is part of the responsibility assigned to them by the Centers for Medicare & Medicaid Services (CMS) as a mandate for…
By
Since it was put into place back in 2013, most of us have managed to grasp the specifics of the Medicare two-midnight rule. Whether there was an anticipation of two midnights of medically necessary care in the hospital at the time of admission, or expectation of a second, medically necessary…