Steven Greenspan, JD, LLM | November 19, 2014

OMHA Requests for Improving the Appeal Process: DI

During the recent Office of Medicare Hearings and Appeals (OMHA) Medicare Appellant Forum held on October 29, 2014, in Washington, D.C., Chief Administrative Law Judge (ALJ) Nancy Griswold indicated that the current OMHA initiatives were moving ahead, but slowly. Judge Griswold also advised the group of 80 in-person attendees, and roughly 500 webinar attendees, that OMHA was committed to reducing the backlog and would shortly be putting out a call …

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Mark Spivey | November 19, 2014

Beyond the RACs – OIG Chief of Staff Answers Que

HHS OIG Chief of Staff Christi Grimm WASHINGTON, D.C. – The Medicare portion of the newly unveiled 2015 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan, the launch of open enrollment in Patient Protection and Affordable Care Act marketplaces, and oversight of an expanding Medicaid program were three topics on the table when HHS OIG Chief of Staff Christi Grimm spoke on Monitor Mondays …

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Ronald Hirsch, MD | November 18, 2014

MACs Attacks Smack of Misinterpretation

While hospitals have been busy weighing the pros and cons of the Centers for Medicare and Medicaid Services (CMS) appeals backlog settlement, preparing their spreadsheets and figuring out if their 68 percent will be 52 percent or 78 percent, the never-ending fun of the two-midnight rule is continuing. Within the last several weeks, the Medicare Administrative Contractors (MACs) have started issuing record requests and the second round of probe audits have …

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11.18.2014
MACs Post Issues for IRFs: What’s Being Watched Now
MACs Post Issues for IRFs: What’s Being Watched Now

As we’ve noted in prior articles, while inpatient rehabilitation facilities (IRFs) have had some relief from Recovery Auditors (RACs), inpatient rehabilitation claims are still under scrutiny from a wide range of auditors, including Medicare Administrative Contractors (MACs), Comprehensive Error Rate Testing (CERT) contractors, Zone Program Integrity Contractors (ZPICs), and Supplemental Medical Review Contractors (SMRCs). And what’s even more disconcerting is...

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10.15.2014
The Current Legal Landscape of Physician-Owned Distributorships
The Current Legal Landscape of Physician-Owned Distributorships

In general, physician-owned distributorships (PODs) are companies with physician owners or investors that sell implantable medical devices to hospitals and healthcare facilities. The revenue generated by PODs typically derives from orders by the PODs’ physician owners, who also use the implantable medical devices for procedures on their own patients at hospitals or healthcare facilities. Although there are a variety of ways...

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10.15.2014
Private Payers After Two-Midnights
Private Payers After Two-Midnights

As we mark the first anniversary of the two-midnight rule, more private payers are opting to implement it – or some principle that is at least based on it.  I received an email from one hospital asking:  “One of our Medicare Advantage plans said that they plan to ‘use the two-midnight rule’ and (that) they will also continue to use ‘evidence-based...

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OIG

OIG Raps MACs in Report to Congress

Steven J. Meyerson, MD | 06.05.2014

OIG Raps MACs in Report to Congress

In its latest (Spring 2014) Semiannual Report to Congress of the Health and Human Services Office of the Inspector General (HHS OIG), Daniel R. Levinson, HHS Inspector General began by...

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Feature Articles

CMS 68% Solution Raises More Issues

Chuck Buck | 09.10.2014

CMS 68% Solution Raises More Issues

Andrew Wachler Tuesday’s national provider call conducted by the Centers for Medicare & Medicaid Services (CMS) to discuss its latest settlement offer raised a number of important questions that still have...

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IRF

Making Every Minute Count: Time for a Wa…

Angela Phillips, PT - avatar Angela Phillips, PT | 10.15.2014

Making Every Minute Count: Time for a Wake-Up Call

The alarm clock is about to ring! Inpatient rehabilitation facilities (IRFs) are being required to report minutes and modes of therapy for all patients discharged on or after Oct. 1,...

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