January 23, 2020
Important Message from Medicare Not Clear
CMS’s IMM sends mixed messages to providers. The Important Message from Medicare (IMM) has changed significantly in its latest reiteration, and the IMM now must be presented to both Medicare and Medicare Advantage patients, according to Ronald Hirsch, MD, who explained during Monday’s edition of Monitor Mondays that both patient…
May 23, 2019
News Alert: CMS Restructures BFCC QIO Regions: KEPRO, Livanta Lose Short-Stay and HWDRG Reviews
A search for a national review HWDRG contractor is expected in the third quarter. In a restructuring of the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) jurisdictions, the Centers for Medicare & Medicaid Services (CMS) has created 10 regions across the United States and awarded KEPRO, a BFCC-QIO, a…
October 19, 2017
Hospital Admissions: Combining Two into One Doesn’t Add Up
Should hospitals combine two admissions into one? In the absence of CMS guidance, hospitals are urged to do the right thing. Today I have a confession to make. For the last five years, I have been lying. Now, don’t get me wrong; I have not been doing it on purpose.…
April 26, 2017
Expect Final Decision on Appeal Cases to Take Years
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…
April 12, 2017
Who is Auditing the RACs?
The first five years of the Recovery Audit Contractor (RAC) audit program created nightmares for many in the provider community. Deadlines were routinely missed at every step of the way. The appeal backlog at the Administrative Law Judge (ALJ) level exceeded three years and does not seem to be getting…
March 29, 2017
Using Condition Code 44 Correctly for Pre-Admissions
Gabby Nunez from Community Memorial Health System in Ventura, Calif. recently asked the RAC Relief user group about the patient who insists on being admitted as an inpatient solely to try to get the three days to qualify for a Part A nursing home payment.This is not an infrequent problem…
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…
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