October 24, 2019
By David M. Glaser, Esq. How Much Weight do MAC Policies Really Carry?
Providers should keep in mind that such policies aren’t binding – but can offer valuable direction. Imagine your Medicare Administrative Contractor (MAC) had a policy detailing their coverage of records documented by a scribe. Say that policy had been revoked. You have located a policy by another MAC, CGS. Would it be…
October 17, 2019
By Marvin D Mitchell, RN, BSN, MBA Decision-to-Admit to a SNF Remains a Documentation Challenge
Documentation is essential in order to avoid RAC problems. On the Sept. 9 edition of Monitor Mondays, Dr. John K. Hall made an excellent presentation on the coming Recovery Audit Contractor (RAC) audits of skilled nursing facility (SNF) decision-to-admit proof of skilled need, and how hospital documentation is essential to…
October 10, 2019
By Edward Roche, PhD, JD Artificial Intelligence is Coming to Medicare Audits – Is Your Legal Team Obsolete?
AI presents an entirely new landscape for defense against audits. The Trump administration has launched a program to employ artificial intelligence (AI) in Medicare audits. Use of AI will make obsolete current legal strategies leveraged when defending providers. On Oct. 3, at a giant rally in Florida, the U.S. President…
October 10, 2019
By David M. Glaser, Esq. How Much Weight do MAC Policies Really Carry?
Providers should keep in mind that such policies aren’t binding – but can offer valuable direction. Imagine your Medicare Administrative Contractor (MAC) had a policy detailing their coverage of records documented by a scribe. Say that policy had been revoked. You have located a policy by another MAC, CGS. Would it be…
September 11, 2019
By Knicole C. Emanuel Esq. Medicare Audits: Deference to the Agency or the Judges?
The appellate court reversed the decision of the ALJ. When you defend an overpayment finding by a Recovery Audit Contractor (RAC) or a termination of a Medicare/Medicaid contract, you present before an administrative law judge (ALJ)in an administrative court. Today I want to write about the strength or deference that…
August 8, 2019
By Knicole C. Emanuel Esq. Medicare Audits: Who Bears the Burden in Your State?
Where the burden lies could make a difference when it comes to the RACs. In a legal lawsuit, one party is initially presumed to be correct and gets the benefit of the doubt, while the other side bears the burden of proof. When a party bearing the burden of proof…