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HRSA is not a HIPAA-covered entity, so the official coding rules do not need to be followed when submitting claims. EDITOR’S NOTE: On this week’s Monitor Mondays, Dr. Ronald Hirsch discussed the Health Resources & Services Administration (HRSA) program, funded by the Coronavirus Aid, Relief, and Economic Security (CARES) Act,…
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Back billing is key to remaining in business during COVID-19. One of the questions that I have heard repeatedly during the continuing COVID-19 pandemic was why numerous clients were being prevented from working during a time in which we seemed to need so many healthcare providers. One of my clients…
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Reimbursement for such services has grown during recent weeks. Many healthcare entities are facing tough economic times. There is a possible solution that benefits patients while also providing revenue that may help healthcare organizations survive.  Send something to all patients explaining that they can use telehealth for nearly all visits…
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The Chicago-area producers of the coveted new testing kits plan to generate 20 million units per month by June. EDITOR’S NOTE: During recent weeks, the Centers for Medicare & Medicaid Services (CMS) has been announcing revisions to its regulatory requirements on a near-daily basis, in an attempt to ease administrative…
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Medicare Advantage plans have reacted to industry criticism of their limited coverage expansion of SdoH. I expected a buzz over our recent Monitor Mondays report and RACmonitor article about the limited coverage expansion of the social determinants of health (SDoH) by Medicare Advantage (MA) plans. Actually, there have been a…
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Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted;…
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Coding Guidelines and Conventions trump Coding Clinic. Hats off to coders.  This group of medical information professionals is required to master one of the most convoluted and confusing set of rules known to civilized man in order to categorize hospital services and submit their findings to insurance companies for billing.…
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HHS ordered back to the drawing board – and told to work quickly. A federal judge has upheld a lower court’s ruling that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced the 2018 Medicare reimbursement rate for drugs covered by the federal…
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Could recoupments be unconstitutional? Case law is changing in favor of healthcare providers who accept Medicare and/or Medicaid. Without question, accepting Medicare and/or Medicaid payments creates a legal risk of regulatory audits. Because the reimbursements constitute tax dollars, the federal and state governments (sometimes via a contracted entity) have the…
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Keeping patients in LTACHs longer than necessary can increase reimbursement. Two years ago, on Monitor Mondays and in the RACmonitor eNews, Ronald Hirsch, MD told the story of one of his patients, Carl, whose stay at a skilled nursing facility (SNF) seemed to be stretched to 20 days to maximize…
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