By
I have written a lot in the past about the two-midnight rule exception for physician judgment of the need for inpatient admission with an expectation of a stay of under two midnights. As a reminder, when the two-midnight rule was first adopted, the only approved exceptions to the two-midnight expectation…
By
With the Recovery Audit Contractors (RACs) returning and the specter of renewed scrutiny looming just around the corner, retrospective review of short-stay Medicare inpatient claims cannot be overlooked. Most providers routinely review these claims when the patient was hospitalized for less than two midnights. As a reminder, the Centers for…
By
Here’s a quick quiz. Imagine that a National Coverage Determination (NCD) lists six conditions for which a treatment is covered. During a review you find dozens of patients who received the treatment for a seventh, unlisted condition. Which of the following is true? You must refund every patient immediately. You must…
By
As I discussed in my RACmonitor article published last week, the Centers for Medicare & Medicaid Services (CMS) has left the mechanics of the two-midnight rule intact in its proposed Inpatient Prospective Payment System (IPPS) rule for 2018. That means that for at least another year, we will have to…
By
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…
By
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…
By
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…
By
Section 6411(b) of the Patient Protection and Affordable Care Act of 2010 (PPACA) requires the expansion of the Recovery Audit Contractor (RAC) program to Medicare Part C. While we may refer to either MA as Medicare Advantage (or a more accurate acronym, MAO, for Medicare Advantage Organizations), the simple fact…
By
When you get a request from a MAC, RAC, ZPIC, BISC or other entity in the alphabet soup of government contractors seeking records for an audit, what should you do?Do you immediately contact your legal counsel? Do you thoroughly review each of the records? This is an area where experts…
By
The word “stoned” is a 1960s slang word meaning roughly “intoxicated on illegal drugs.” The United States currently has an opioid epidemic. It has grown quickly, and now is of huge proportions. For the second time in only a few months, two U.S. parents were arrested because police found them…
Page 4 of 5