Gracielinda Prescott | October 15, 2014

The Current Legal Landscape of Physician-Owned Dis

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 in which POD arrangements are structured, they generally offer physician …

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Gracielinda Prescott | October 15, 2014

Using Audit to Bridge the Language Barrier

  The relationship between healthcare payers and providers is often complicated, tumultuous, and adversarial. The drastic increase in Recovery Auditor (RAC) and other third-party payer audits over the past several years has exacerbated this issue. During a recent provider-payer panel session at the HealthPort’s annual Health Information (HIM) Education Summit, the presence of a deep language barrier dividing these entities became clear. Plan representatives mentioned that some providers understand their requests, but …

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David M. Glaser, Esq. | October 15, 2014

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 guidelines.’ My question is ‘can they do it?’” That is an …

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10.01.2014
CMS Throws New Wrench into 68-Percent Settlement Offer Decision
CMS Throws New Wrench into 68-Percent Settlement Offer Decision

On Sept. 30, the Centers for Medicare & Medicaid Services (CMS) held a hospital open-door forum in which the first item on the agenda was the 68-percent settlement offer on pending appeals. After a review of the basics of the offer, CMS representatives entertained questions. One provider inquired about a common scenario: an admission having been denied by an auditor, the...

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10.02.2014
Now You See It, Now You Don’t
Now You See It, Now You Don’t

In its continued effort to force transparency on everyone but itself, the government, through the Centers for Medicare & Medicaid Services (CMS), has released another data dump that is supposed to shed light on the financial relationships between vendors and healthcare providers. In reality, what it does shed is just more noise and confusion on an already noisy and confusing issue....

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10.02.2014
Auditing Modifiers
Auditing Modifiers

It is not enough to merely audit the codes billed by the provider of healthcare services. You also must review the modifiers appended to the services to validate that they were used in an appropriate manner. The modifiers must be validated to verify that their use is corroborated within the medical documentation and medical necessity of the medical record. Coders, billers,...

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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

FY 2015 Final Rule: Summary for Inpatien…

Angela Phillips, PT - avatar Angela Phillips, PT | 09.04.2014

FY 2015 Final Rule: Summary for Inpatient Rehabilitation Facilities

The Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule for the 2015 fiscal year was published on Aug. 6, 2014. The final published rule: Updates the federal prospective payment rates...

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