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Joint Commission decision on ligature risks raises questions. Hospital surveyors, in particular Joint Commission surveyors, are placing a major emphasis on ligature risks—the risk that suicidal patients will be able to hang themselves in the hospital. From my limited experience, it appears that the Joint Commission may be going beyond…
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Judge orders AHA to submit its recommendations by June 22, 2018.  Recently there was a new development in the matter of American Hospital Association, et al., v. Azar (14-cv-00851-JEB)1. This case arises out of a lawsuit filed in 2014 by the American Hospital Association (AHA) and a group of hospitals…
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If this hospital was targeted by the DOJ, where does that leave everyone else? Today I have a great mystery to present. Last week the U.S. Department of Justice (DOJ) announced a $1.88 million False Claims Act settlement with Genesis Medical Center in Davenport, Iowa. In the settlement, the DOJ…
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OIG audits device credit reporting. The confluence of two major healthcare news stories is creating confusion among providers. News of changes to the national coverage determination (NCD 20.4) for implantable cardioverter defibrillators, as first reported by Ronald Hirsch, MD, for RACmonitor, nearly collided with a report on device credit from…
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The main burden for this change is on healthcare providers such as physicians, clinics, hospitals.  The Centers for Medicare & Medicaid Services (CMS) will start issuing the new Medicare cards with the MBI (Medicare Beneficiary Identifier) number beginning April 1. The Social Security Number (SSN) based HICN (Health Insurance Claim…
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The DOJ has focused particularly on the payment of kickbacks that induce physicians to prescribe more, or more expensive, opioids. Last week, President Trump unveiled the administration’s new plan to combat the opioid epidemic. In 2016, more than 11 million Americans misused prescription opioids, resulting in 42,000 related deaths and…
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For one health system, staying the 340B drug program makes financial sense. Working at a large teaching hospital in Pennsylvania recently, I was able to ask the system CFO if he was thinking of giving up on the 340B program in light of the cuts. I was surprised by his…
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Hospitals must perform medical screening evaluations to patients presenting at emergency departments. Anthem Blue Cross Blue Shield, the nation’s largest health insurer, instituted a policy last year of not paying for emergency department care if they retrospectively determined the visit was non-emergent. It started in Georgia, Missouri, and Kentucky, and…
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Questions still linger regarding specifics of implementation. By Mark Spivey Arkansas has become the nation’s third state to implement a work requirement for Medicaid, according to an announcement made earlier this week by Governor Asa Hutchinson and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. The state expects…
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All audits are questionable, contends the author, so appeal all audit results. Providers ask me all the time – how will you legally prove that an alleged overpayment is erroneous? When I explain some examples of mistakes that Recovery Audit Contractors (RACs) and other health care auditors make, they ask,…