Ronald Hirsch, MD, FACP, CHCQM | December 17, 2014

DEVELOPING STORY: New Home Health Requirements Eas

On Dec. 16, the Centers for Medicare &Medicaid Services (CMS) presented an open door forum on the new home health certification requirement that becomes effective on Jan. 1, 2015. The 2015 Home Care Prospective Payment Final Rule, CMS-1611-F, made significant changes to the face-to-face requirement that was mandated by the Patient Protection and Affordable Care Act (PPACA). Noting that the improper payment rate for home health services far exceeded the rates …

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Frank Cohen, MPA | December 17, 2014

What’s Hot and What’s Not: 2014 Analytics in

By most accounts, 2014 was a tumultuous year for healthcare providers. The administrative law judges (ALJs) suspended the scheduling of hearings while the Centers for Medicare & Medicaid Services (CMS) suspended Recovery Auditor (RAC) audits due to contractual disagreements with the RACs themselves. Reversal rates on appeals skyrocketed and to help clear up the backlog, CMS offered a limited number of facility types performing limited services the opportunity to pay …

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David M. Glaser, Esq. | December 17, 2014

Medicare Myths: Common Misperception about Medicar

 Which of the following are true?   •  The Medicare Administrative Contractor (MAC) has complete legal authority to determine whether a service is medically necessary. •  You must bill exactly the same charge to all patients who receive the same service.  •  It is an overpayment if a note is not signed.  •  Nurse practitioners and physician assistants can’t bill for high-level visits. •  If it isn’t written, it wasn’t done. Surprisingly, none of these statements are …

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11.27.2014
The Use of Condition Code 44 by Medicare Advantage Plans
The Use of Condition Code 44 by Medicare Advantage Plans

A recent email from a Midwest hospital presented the following dilemma: “(Big national insurer’s) Medicare Advantage (MA) replacement plan is advising us that we have to use a condition code 44 on their claims when we change from inpatient to observation. And we do a lot of these, at their request! For some reason, I remember, that the discussion on...

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11.27.2014
Inpatient Rehab Facilities 2014: FAQ’s
Inpatient Rehab Facilities 2014:  FAQ’s

As we reach the end of the year, it’s a good time to highlight some of the common questions that continue to resurface for IRFs. This segment of our ongoing articles will summarize some of the common questions we hear and provide guidance on how IRFs can address them. 1/1/2010 and Beyond Q: It’s 2014, why is there still so much focus...

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11.27.2014
DOJ Touts Recovery of $2.3 Billion in False Healthcare Claims
DOJ Touts Recovery of $2.3 Billion in False Healthcare Claims

WASHINGTON, D.C. – False claims against federal healthcare programs generated approximately 40 percent of the record $5.7 billion in recovered funds associated with civil cases involving fraud against the government during the most recent fiscal year, according to a press release issued late last week by the U.S. Department of Justice (DOJ).  The approximately $2.3 billion in recoveries tied to false...

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11.18.2014
Documentation: Intent Versus Content
Documentation: Intent Versus Content

  Electronic medical record (EMR) products have brought automation to the healthcare industry, but does healthcare really need to be automated? The intent of creating a storehouse of all health information was such that when you go to a new provider they now would have all of your records (or when you get in a car wreck out of town, you would...

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OIG

Mandatory Reading: 2015 U.S. Department …

Elizabeth Lamkin, MHA | 11.05.2014

Mandatory Reading: 2015 U.S. Department of Health and Human Services Office of Inspector General Work Plan is Published

  As you may be aware, the 2015 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan was released on Oct. 31, 2014. This should...

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Feature Articles

Last Rites for Inpatient Admission Certi…

Ronald Hirsch, MD, FACP, CHCQM | 12.17.2014

Last Rites for Inpatient Admission Certification

Over the years I have heard many say that they would like to be able to attend their own funeral, so for the last update of the year, I thought...

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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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