UnitedHealth says it will use proprietary software to deny claims. EDITOR’S NOTE: The topic of this article was previously covered by RACmonitor on separate occasions in 2017 and 2018. To welcome the new year, UnitedHealthcare (UHC) has announced that starting April 1, 2020, they will use a proprietary software program…
OPPS rule could result in higher revenue. Whenever a rule changes, expect Recovery Audit Contractor (RAC) and/or targeted probe-and-educate (TPE) audits to hone in on the topic associated with the altered rule – and expect auditors to forget when the rule actually changed. Physician supervision has been a hot topic…
The Court ruled that California may not compel the clinics with religious concerns to promote or advertise abortion options. When can the government require speech? While many people think of the recent Supreme Court decision involving family clinics in California as an abortion case, the analysis of the case centers…
Release of outdate guidelines raises fears that other MACs might adopt them to audit providers. The use of outdated definitions of malnutrition by a Medicare Administrative Contractor (MAC) is raising concerns that other MACs may adopt the same flawed practice. The universally accepted definitions, known as the American Society for…
“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…