Physician documentation has evolved over the last 10 years to the point that some would say it has deteriorated in the quality of its purpose. There are multiple factors driving this trend, some with more prominence than others. In 1971, revolutionary thinker Dr. Lawrence Weed introduced the concept of the SOAP note, an acronym for subjective objective assessment plan. Known as the “father of the problem-oriented medical record,” Dr. Weed recognized that …Read more
Hospital inpatient reimbursement continues to be at risk whether or not third-party payers are actively auditing for recoupment. In addition to Medicare fee-for-service, many payers reimburse inpatient stays based on MS-DRGs or some form of DRG system. Inpatient hospitalization is a costly level of care, and hospitals need to assure that the correct DRGs are being assigned and billed to receive proper reimbursement for the conditions treated and services provided. While Recovery …Read more
Private insurance audits used to be rare, but over the last few years, they seem to be on the increase. The initial contact from a private insurer may ask you to submit written records or it may include a request for a site visit. The first thing you want to do is review any contract you have with the payer and determine whether it allows the audit. You will also want …Read more
The Centers for Medicare & Medicaid Services (CMS) signed contracts last week with the incumbent RAC contractors to provide limited Recovery Audit services through April 30, 2016, according to Monitor Mondays legislative analyst Emily Evans. Evans, a partner with the Obsidian Research Group, said the contracts, valued at around $200,000, would be for limited RAC services. “RACs will be permitted to handle...Read more
Today’s hospitals have to do a lot more with a lot less. Obviously, organizations would rather focus on patient care and not red tape. But the reality is that hospitals must spend more and more time lately on back-end administrative processes – including compliance, audit management, and denials – in order to direct more dollars to the front end. Many hospitals...Read more
I am opposed to the Eighteenth Amendment to the U.S. Constitution, which prohibits the manufacture, transportation, and sale of alcohol. I think that prohibition has done more harm than good and that alcohol should be legal to sell and consume in the United States. I therefore call on Congress to hold hearings on repealing the Eighteenth Amendment. Oh, wait, it was...Read more
A few weeks ago, the Office of Medicare Hearings and Appeals (OMHA) announced what it described as a way to clear up the current federal backlog of appeals and move the process forward more efficiently. Of particular interest is the Statistical Sampling Pilot Program. Also of some interest is that the Centers for Medicare & Medicaid Services (CMS) has been conducting...Read more
Hospital life changed forever on Tuesday, October 1, 2013 with the Inpatient Prospective Payment that promulgated the controversial "two-midnight rule." As hospitals approach the anniversary of the two-midnight rule, what lessons can be learned? What issues surfaced this year with the implementation of the two-midnight rule in health systems with multiple electronic health records (EHR) systems in multiple settings?
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