Last week the Centers for Medicare & Medicaid Services (CMS) released data on the reimbursement Medicare pays to individual physicians. The data provides a great illustration of one of the challenges of healthcare: it is risky to trust data, and it is risky to dismiss it. There is another risk of data as well: sometimes its mere existence can change behavior. This may seem counterintuitive, but sometimes data can actually increase …Read more
As many of you know, several weeks ago the Centers for Medicaid & Medicare Services (CMS) issued Transmittal 505, which would have allowed auditors to deny what they labeled “related claims” without any further record review. There was rejoicing, as this would allow the denial of physician claims when an admission is denied, meaning doctors would finally have some skin in the game. The transmittal gave two examples: when denial of a …Read more
Ever since the two-midnight rule became effective on October 1, 2013, industry discussion about audits has centered on one-midnight stays because these are the most vulnerable to admission status error and thus to the risk of denial or recoupment at the hands of a Medicare contractor. Admission documentation for one-midnight stays will be under intense scrutiny: Did the physician sufficiently document both the need for hospital care and the basis …Read more
At a time when moviegoers are flocking to see the biblical epic “Noah,” in which the titular protagonist goes about collecting the world’s species by twos, the American Hospital Association (AHA) on Tuesday filed a pair of lawsuits against the U.S. Department of Health and Human Services (HHS), challenging the contentious “two-midnight” rule for determining inpatient status. Meanwhile, in a...Read more
If you are running a hospice and are not under audit by one of the many governmental bodies out there, you are either very lucky or you are fibbing. The pattern has expanded to include Medicaid through a variety of subcontractors here in Florida. Many of the hospices across the country are scared even to reach out to their trade groups...Read more
Can coders infer or deduce from the medical record? It’s elementary, my dear physician. During a recent Monitor Monday broadcast, I postulated that coders could draw some conclusions from medical records. In particular, I asserted that if the records contain facts that demonstrate that a patient has a particular diagnosis, but the records don’t include the actual label, I believed the...Read more
On Feb. 5, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 505,1 and then, on March 19, it rescinded the transmittal.2 At issue was the concept of “related services” and the ability of government auditors to recoup payments from associated providers when there is a denial for only one of the providers. For instance, if a surgical procedure...Read more
Our prescription for avoiding the miscoding epidemic
"In our audits, we regularly see coding accuracy rates of 50% to 75% for outpatient infusion services," reveals Panacea consulting expert Robin Miller Zweifel. "In our HIM and CDM procedure coding audits for other lines of service, we typically look for an accuracy percentage of 90% or more." Even more shocking, she adds, this has been the recurring...
| RACmonitor.com, a division of Panacea Healthcare Solutions, Inc.
287 East 6th Street | Suite 400 | St. Paul, MN | 55101 • TOLL FREE: 866.829.6612