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The June Medicare Payment Advisory Commission (MedPAC) report to Congress included recommendations for a Unified Prospective Payment System for Post-Acute Care services. Specifically, the report recommended that Congress direct the Secretary of the U.S. Department of Health and Human Services (IRF) to undertake the following: Implement a prospective payment system…
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Medicare Advantage (MA) programs continue to gain popularity, with about one-third of Medicare beneficiaries currently enrolled in a variety of MA programs. MA plans are issued by MAOs, or Medicare Advantage Organizations, that are typically insurance companies. Medicare beneficiaries are attracted to these programs because they offer increased coverage for…
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If you listened to last week’s edition of the RACmonitor-produced Internet broadcast Monitor Mondays, you heard a reminder from Nancy Beckley that the Centers for Medicare & Medicaid Services (CMS) has released a new version of the Advance Beneficiary Notice (ABN), and that using the old version will automatically render…
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The recently filed federal whistleblower lawsuit alleging that tens of billions of dollars in improper payments were made to insurers by Medicare Advantage over the course of several years could be just the tip of the iceberg, according to the attorneys for the plaintiff in the case. The suit was…
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With the Recovery Audit Contractors (RACs) returning and the specter of renewed scrutiny looming just around the corner, retrospective review of short-stay Medicare inpatient claims cannot be overlooked. Most providers routinely review these claims when the patient was hospitalized for less than two midnights. As a reminder, the Centers for…
By Laurie A. McBrierty, MLT, ASCP and Cari Greenwood, RHIA, CCS, CPC
Changes in reimbursement policies, laws, and regulatory oversight are forcing healthcare organizations to respond to increased regulatory scrutiny and audits. Medicare audits have increased 936 percent in the last five years alone, according to Becker’s Hospital CFO, and ad hoc inpatient audits are no longer enough of a defensive strategy.…
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After more than 18 months of planning by the Centers for Medicare & Medicaid Services (CMS) and a mad scramble by hospitals in response to last-minute guidance, the Medicare Outpatient Observation Notice (MOON) is now the law of the land, and has been since it became effective March 8, 2017.…
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It has been a busy two weeks. Ten days ago, the Centers for Medicare & Medicaid Services (CMS) released the proposed 2018 Inpatient Prospective Payment System (IPPS) rule, which, as usual, came out late on a Friday afternoon. The good news about the Rule is that the agency did not…
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For those for you who are regular listeners to Monitor Mondays, you heard Dr. Ronald Hirsch in his April 10 ”Monday Rounds” segment discuss an article recently published online by the Journal of Hospital Medicine detailing the appeal process of Recovery Audit Contractor (RAC) denials at three academic hospitals. I…
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A powerful U.S. Senator is demanding answers regarding the perceived ineffectiveness of Centers for Medicare & Medicaid Services (CMS) efforts to address apparently sizeable overpayments to Medicare Advantage plans. U.S. Sen. Chuck Grassley (R-Iowa) earlier this week sent a letter to newly confirmed CMS Administrator Seema Verma asking pointed questions…