I have whined in a previous RACmonitor enews article about how the importance given to the admission order in today’s healthcare industry makes absolutely no sense. It’s not an order for a medication or a test, wherein if it is transcribed incorrectly, the patient could be physically harmed. The admission…
Unique opportunity. Hospitals urged to use great discretion. The Centers for Medicare & Medicaid Services (CMS) wants to know if your total knee replacement (TKR) claims have been denied. Ronald Hirsch, MD, made the announcement today during the weekly broadcast of Monitor Mondays when he reported that he has received…
If there is a pattern of inappropriate denials, report it to your CMS regional office  Are all of you refreshing your browser every 15 minutes waiting for the Centers for Medicare & Medicaid Services (CMS) to release the Outpatient Prospective Payment System (OPPS) proposed rule? I didn’t think so. But…
Uncertainty remains regarding specifics of documentation. A couple of weeks ago I talked about the new national coverage determination (NCD) for defibrillators. At the time, the effective date was not known. Well, it is now clear: it was effective immediately. That NCD also added the requirement for a formal shared…
The Centers for Medicare & Medicaid Services (CMS) announced Monday that it would start a new national audit strategy titled Targeted Probe and Educate (TPE) after pilot programs with four Medicare Administrative Contractors (MACs) demonstrated success.  CMS described that success as “including an increase in the acceptance of provider education…