The nation’s largest city saw its cases soar past the 1,000 mark this week. I wish that I was writing under better circumstances, but these are difficult times in New York, and across the United States. As of Tuesday, New York State had more patients identified with COVID-19 than any…
Law professor Dershowitz tests the “one purpose test.” During the recent impeachment trial of President Trump, Alan Dershowitz made a statement that was widely interpreted as saying that if a politician had multiple motives for a particular activity, but one of the motives was benefiting the public interest, any nefarious…
ED physicians and healthcare providers are a distinct breed – whales in a sea of fish. After all, emergency room doctors have, for the most part, been overlooked by the Recovery Audit Contractor (RAC) auditors (or TPE, Targeted Probe-and-Educate; ZPICs, Zone Program Integrity Contractors; or Medicare Administrative Contractors, MACs). Maybe…
CMS report is based on 2016-2017 data. It’s been two years since the American Hospital Association (AHA) shouted from the rooftops that documentation by any interprofessional team would be accepted as validation to use the ICD-10-CM Z codes, as opposed to only documentation by physicians. In the social determinants of…
CMS launches healthcare outcomes challenge. Expect more artificial intelligence (AI) in healthcare in 2020. We will see AI used primarily in diagnostics and auditing. In each of these areas, AI promises to impose drastic changes on society. As these changes reverberate through organizations, old work patterns will be disrupted. In…
The absence of a physician’s signature should not result in denial of a Medicare claim. As a regulatory and compliance officer, I often have the privilege of working with some of the best and most respected attorneys in the industry, and Monday, during Monitor Mondays, was no exception. Attorney David…
Monitor Monday's listeners polled for proposed solutions. 2020 began as it ended, with the healthcare industry fixation on every nook and cranny of the social determinants of health (SDoH). Many experts are still reeling from allegations of inherent bias in algorithms used across the nation. And a new study involving…
Same old New MOON, but potential problems appear in two of the other three new forms. All federal forms require periodic review and reapproval by the Office of Management and Budget (OMB). The approval is indicated on the form by a unique number and an expiration date. The Centers for…
MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG.  The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a study that should cause a chill to run down the spines of hospital and Medicare Advantage plan leaders alike.…
EDITOR’S NOTE: While presenting at the recent New England Healthcare Internal Auditors (NEHIA) annual conference in Connecticut, Knicole Emanuel encountered the recurring audit topic of positive airway device supplies or PAPs. The following is her report. Back in 2014 and 2015, then again in 2018, PAPs were the main area…