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Taking a look at whether approaches that yield results in other fields could do so in healthcare, too. Sometime around August of last year, I wrote an article about risk-based auditing: whether it was something real and tangible, or just another buzzword that was being tossed about and abused. Defining…
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CMS guidance about medical review changes for inpatient rehabilitation facilities (IRF): Bonus or baggage? There has been lots of buzz about Medicare’s most recent clarifications to contracted auditors related to auditing therapy minutes for inpatient rehabilitation facilities (IRFs). The news first surfaced on Dec. 11 in MLN Matters SE17036, which…
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Clarity is badly needed for the quarterly health data report. Every quarter, the quality representatives at most hospitals receive their Program for Evaluating Payment Patterns Electronic Report (PEPPER), and every quarter the quality representatives struggle to figure out what to do with the data. And this quarter, TMF, which produces…
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For implanted cardioverter defibrillators, (ICDs) there is no national coverage determination (NCD), nor is there an implementation date. As we have reported in past editions of RACmonitor eNews, the national coverage determination (NCD) for placement of implanted cardioverter defibrillators (ICDs) was recently updated. As I reported last week, the changes…
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Recent press coverage misleadingly suggested that the ruling was a serious setback to the government’s suit, which is not the case. On Feb. 12, 2018, a federal judge in the Central District of California issued his ruling on the UnitedHealth Group’s (UHG) motion to dismiss the government’s complaint in one…
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Uncertainty remains regarding specifics of documentation. A couple of weeks ago I talked about the new national coverage determination (NCD) for defibrillators. At the time, the effective date was not known. Well, it is now clear: it was effective immediately. That NCD also added the requirement for a formal shared…
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Guidance on a common unbundling modifier has shifted frequently during the last decade. Anthem Blue Cross Blue Shield (BCBS) were set to implement a new processing edit with regard to the use of Modifier 25, effective March 1, 2018, but things didn’t go as planned. Anthem instead submitted a letter…
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CMS open door forum reveals clarity of policy still lacking for total knee replacements.  We are two months into 2018, and the level of clarity regarding how to determine the status of Medicare patients undergoing elective total knee replacements is no better than it was on the day in November…
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OIG report shines spotlight on area of confusion for billing. In a recent report, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced it has determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities.…
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Every patient receiving an ICD for primary prevention will be required to have an encounter for shared decision-making using an evidence-based decision tool. The Centers for Medicare & Medicaid Services (CMS) has released a final decision memo on changes to the national coverage determination (NCD) for implantable cardioverters defibrillators (ICDs).…