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…
The biggest hurdle providers face is the prospective nature of the payment system. It was always a black hole. The Medicare Provider Reimbursement Review Board, or the PRRB, as it is commonly called, decided whether hundreds of Medicare cost report appeals would move forward or would be blocked for “jurisdictional…
EDITOR’S NOTE: CORRECTION:  In the RACmonitor Nov 29, 2019 edition, Dr. Ronald Hirsch noted that resource use data on skilled nursing facilities (SNFs) was not available on the SNF Compare website. Upon further investigation, the resource use data is, in fact, available indirectly from the SNF Compare home page. Subregulatory…
EDITOR’S NOTE: Healthcare attorney David Glaser reported on the CMS final rule’s reference to “shoppable” services during today’s edition of Monitor Monday. The following is his report. On Nov. 15, the Centers for Medicare & Medicaid Services (CMS) released an advanced copy of a final rule that will require all…
EDITOR’S NOTE: Virginia Gov. Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Sept. 25, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.…
Addressing SDoH from an acute care perspective.  “Non-compliant:” please, remove this from your lexicon. It’s a pejorative doing injustice to patients and providers alike.  “Barriers to adherence to a prescribed regimen” is a better descriptor. The behavior has context. Patients very often have obstacles to optimal wellness, some self-inflicted, some…