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UnitedHealthcare (UHC) is joining the ranks of those carriers that no longer cover consult codes (99241-99245 and 99251-99255), effective Oct. 1, 2017. This notification was released in UnitedHealth’s June 2017 bulletin in which it noted its commitment to ensure that there will be multiple communications to clarify this change. UHC…
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“I see it all perfectly; there are two possible situations – one can either do this or that.” You would be forgiven if you thought this quote was about a Medicare policy concerning whether a patient could either continue with curative treatment or enter into hospice care. You would be…
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David Glaser’s excellent article provides an update on the recent court ruling on the Medicare appeals backlog. Understanding legal opinions generally can be nearly impossible if one is not a lawyer, and this 37-page decision is no exception. Even after reading David’s article, I still have trouble wrapping my head…
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With rising healthcare costs and the number of Medicare beneficiaries growing rapidly nationwide, the pressure on the federal government to recover improper Medicare payments will only increase. A recent opinion piece in Forbes, written by a spokesperson for the Council for Medicare Integrity, presents a view of the prevailing thought…
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“Admit as inpatient” are probably the most valuable words written or electronically entered by physicians. And to be honest, I think the Centers for Medicare & Medicaid Services (CMS) has a little too much psychological and physical dependence on these words. Is a patient any less a patient because those…
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EDITOR'S NOTE: Edward Roche, in association with RACmonitor, is writing a series on the need for U.S. healthcare facilities to protect themselves from cybercriminals demanding ransoms for patient records. This is the eighth installment in the series.  Hospitals can mitigate the damage from a cyberattack by engaging in simulations designed…
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EDITOR'S NOTE: Edward Roche, in association with RACmonitor, is writing a series on the need for U.S. healthcare facilities to protect themselves from cybercriminals demanding ransoms for patient records. This is the seventh installment in the series. Cybercrime is on everyone’s minds these days, even when there is a Medicare…
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The topic of Condition Code 44 is not new. Detailed by the Centers for Medicare & Medicaid Services (CMS) in September 2004 via MLN Matters SE 0622, titled Clarification of Medicare Payment Policy When Inpatient Admission is Determined not to be Medically Necessary, Including the Use of Condition Code 44:…
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More than 400 people across the country have been charged in connection with $1.3 billion in healthcare fraud losses as part of what the federal government has labeled the largest enforcement action of its kind in U.S. Department of Justice (DOJ) history. United States Attorney General Jeff Sessions and U.S.…
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EDITOR’S NOTE: The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) reported yesterday that Wisconsin Physicians Service Insurance Corporation (WPS) did not properly settle for federal fiscal years (FYs) 2010 through 2012 Medicare cost reports submitted by inpatient hospitals in Missouri for Medicare…