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Vote on the continuing resolution (CR) helps providers with Advanced Payments. The U.S. Senate passed a continuing resolution (CR) this evening, which will keep the federal government open through the middle of December. As the government’s fiscal year ends today (Wednesday) at midnight, the CR was passed just in time.…
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Providers forced to camouflage in mediocrity.  EDITOR’S NOTE: This the first in a series of articles that explores the use of algorithms in the auditing of medical claims. The Centers for Medicare & Medicaid Services (CMS) has pioneered the use of computer algorithms for detection of fraud. These efforts leverage technologies…
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Telehealth and immunizations are two of numerous services targeted for revision. Federal officials are seeking public comments from providers on an expansive set of sweeping revisions to policies governing Medicare payments. The Centers for Medicare & Medicaid Services (CMS) announced the recommended revisions via a proposed rule issued late last…
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Minorities have been found to be disproportionately affected by adverse outcomes. Federal officials say their first monthly statistical update illustrating the impact of the COVID-19 virus on the Medicare population leaves no doubt: minorities are being disproportionately affected by the continuing pandemic.   The Centers for Medicare & Medicaid Services…
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Today is the first day that prior authorization is required for Medicare beneficiaries to undergo specific surgeries. Here are the 10 things you need to know about the program. Five types of surgery – blepharoplasty, botulinum toxin injections to the face, panniculectomy, rhinoplasty, and vein ablation – performed on traditional…
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It is the hospital’s responsibility to obtain the prior authorization.  We are two weeks away from the start of the Medicare prior authorization program, and as of June 17, the Medicare Administrative Contractors (MACs) were required to start accepting requests. As a reminder, five procedure classes will need prior authorization:…
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There is continued confusion over the use of patient homes as off-campus, provider-based clinics for Medicare billing purposes. This is the provision in the Centers for Medicare & Medicaid Services’ (CMS’s) second recent Interim Final Rule (IFR) that allows hospitals to bill for services provided by employed hospital staff, such…
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Providers and federal officials alike continue to adjust to the new normal, and an uncertain future. EDITOR’S NOTE: Dr. Ronald Hirsch, vice president of R1 RCM, and healthcare attorney David Glaser, of Fredrikson and Bryon, reported these two stories during this week’s live edition of Monitor Mondays. What follows are…
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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…
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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…