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The Unified Program Integrity Contractors (UPICs) may need lessons in reading patient notes. Should they be "defunded?" These days, everyone has a horror story about an audit. There are arrogant know-it-alls that show up unexpected, embarrassing the provider in front of their patients. "He must have done something wrong, otherwise…
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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  Say that policy had been revoked.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…
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Chapter 8 changes appear to be less fair than ever before. “Life Isn’t Fair, but Government Must Be”— Former Texas Governor Ann Richards, 1991 Everyone has a plan until they get punched in the mouth, according to Mike Tyson, retired boxer and armchair philosopher. And it appears that the Centers…
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Improper use of extrapolation statistics is stunningly egregious, according to the author. Over the years, I have written extensively about the statistical extrapolations that are a large part of the audit process. In general, auditors—both government and private—make use of the extrapolation to significantly increase the overpayment estimates imposed on…