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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…
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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…
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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…
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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…
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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…