Indeed, it was another “Dantastic” Monday as Inspector General Dan Levinson took the podium to deliver the keynote at the 21st Annual Compliance Institute in National Harbor, Maryland.  Dan opened with the discussion of a January Health Care Compliance Association (HCCA) U.S. Department of Health and Human Services Office of…
On the next edition of Monitor Mondays, Mary Beth Pace, vice president of care management at Trinity Health, will share how her health system is traversing the new compliance landscape of the MOON: the Medicare Outpatient Observation Notice, which became effective March 8. What are they discovering, and how are…
There is no doubt that state Medicaid Fraud Control Units (MFCUs) have their hands full and are charged with a difficult task. They are responsible for investigating Medicaid fraud. This is part of the responsibility assigned to them by the Centers for Medicare & Medicaid Services (CMS) as a mandate for…
The Centers for Medicare & Medicaid Services (CMS) will be changing the criteria for short-stay audits in April, according to KePRO, one of the Medicare Quality Improvement Organizations (QIOs), which posted the announcement on its home Web page.“CMS is changing the selection process for medical records for short-stay reviews,” the…
With unusual bipartisan support, a new piece of legislation of about 1,000 pages was signed into law on Dec. 13, 2016 – the 21st Century Cures Act. The Act will allocate about $6 billion to a variety of medically related needs. While the bill has received both applause and criticism…
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a mystery to many. Sent to hospitals as an Excel workbook, I find it to be data-rich but information-poor.There are 56 pages of explanations, data, and tables. To make it even more frustrating, no one seems to really know who…
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