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CMS is encouraging the integration of healthcare providers so that their size is increased to have averaged payments represent a break-even or better. CMS (the Centers for Medicare & Medicaid Services) views payment from a national perspective on a statistically averaged basis. Individual providers such as physicians, clinics, hospitals, home…
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Providers should consider how to optimize the patient’s health status prior to discharge to hospice. In his RACmonitor article of Aug. 8 regarding the recent proposed final rule for inatient amission orders, Dr. Ronald Hirsch reported that the Centers for Medicare & Medicaid Services (CMS) added inpatient transfers to hospice…
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In FY 2019, hospital performance in the HRRP will be assessed relative to hospitals within the same peer groups. Since 2013, Medicare has penalized hospitals that have an “excessive” number of readmissions under a program called the Hospital Readmissions Reduction Program, or HRRP. The Centers for Medicare & Medicaid Services…
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2019 IPPS removes requirement for authentication of admission orders prior to discharge. EDITOR’S NOTE: This is the second and final installment of a two-part series. By Ronald Hirsch, MD, FACP, CHCQM Last week I tackled the easy part, interpreting the new Centers for Medicare & Medicaid Services (CMS) regulations on…
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CMS continues to help hospitals impacted by the aftermath of Florence No sooner had Monitor Monday signed off on Monday’s program with live reports from the areas ravaged by Florence, then the Centers for Medicare & Medicaid Services (CMS) published a notice that is intended to ease emergency preparedness regulatory…
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CMS provides Medicare waivers for providers dealing with natural disasters. I live in North Carolina, and as most of you have seen on the news, we just underwent a natural disaster. Its name is Hurricane Florence. Our Governor has declared a state of emergency, and this declaration is extremely important…
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2019 IPPS removes requirement for authentication of admission orders prior to discharge. EDITOR’S NOTE: This is the first installment of a two-part series. When the Centers for Medicare & Medicaid Services (CMS) finalized the 2019 Inpatient Prospective Payment System (IPPS) Final Rule, hospitals across the country breathed a deep sigh…
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RAC issue for IRFs has moved from being proposed to being approved. The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex Medical Review for (inpatient rehabilitation facilities) IRFs. The issue: 0A024-Inpatient Rehabilitation Facility (IRF) Stays: Meeting Requirements in the proposed Recovery Audit Contractors (RAC) Topics list…
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Once a denial is issued, a P2P will no longer be an option. An astute physician advisor recently brought to my attention a change to the Humana Medicare Advantage peer-to-peer (P2P) process. The announcement (which can be found at this link: https://www.humana.com/provider/support/publications/your-practice-newsletter/peer-review-process-changes) states that effective Aug. 1, a P2P with…
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This question can help you evaluate lawyers EDITOR’S NOTE: This is the second and final installment in a two-part series as to when facilities should voluntarily refund an overpayment. It can be difficult to know if you’re getting good advice from your lawyer, but here is a good test to…