WASHINGTON, D.C. – The announcement of the new pilot program from the Office of Medicare Hearings and Appeals (OMHA) intended to help mitigate the highly publicized backlog of appeals at the Administrative Law Judge (ALJ) level came at a propitious time last week, against a backdrop of two pertinent hearings on Capitol Hill. OMHA’s Settlement Conference Facilitation Pilot (SCF) was quoted in a staff report from the U.S. Senate’s Special Committee …Read more
Earlier this month RACmonitor informed us of the new U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) release encouraging the Centers for Medicare & Medicaid Services (CMS) to place more scrutiny on evaluation and management (E&M) services, with the suggestion based on the staggering statistics surrounding improper payments for these services. E&M services often are selected incorrectly due to the level assigned being based on documentation …Read more
In a June 19 article I wrote for RACmonitor titled “Four Myths about IPPS Best Practices – And Why You Shouldn’t Believe Them,” I noted that one of the most common misconceptions in our industry is that there will be no more audits until April 1, 2015 at the earliest – or, as some are even thinking, that audits are gone for good. This certainly is not the case, as Medicare …Read more
Dr. MeeskeCredit: ADA The subject of Medicaid RAC audits found its way into the conversation at the recent roundtable meeting entitled “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations,” hosted by the U. S. Senate Special Committee on Aging. Jessica Meeske, DDS, a dentist who serves Medicaid patients in rural Nebraska, related the story of the first Medicaid...Read more
The probe-and-educate phase is in full swing, with hospitals receiving results of their probe audits and Medicare Administrative Contractors (MACs) conducting extensive education, performing both one-on-one sessions with hospitals and conducting general education via webinars and teleconferences. The one-on-one sessions vary among MACs; in some instances the MAC representative presents general education about the two-midnight rule in a lecture format, some...Read more
As health system leaders continue to react to continuously updated regulations, many have been expressing their concern for the ongoing administrative burden that exists because of expanded Medicare oversight and its Recovery Auditor (RAC) audit program. Their focus, of course, remains on compliance, and ensuring that providers respond to audit requests in a timely and accurate manner. However, until recently, as...Read more
The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) has issued an April 2014 report recommending a significant payment change. The report boasts a rather impressive title: “Medicare and Beneficiaries Could Save Billions If CMS Reduces Hospital Outpatient Department Payment Rates for Ambulatory Surgical Center-Approved Procedures to Ambulatory Surgical Center Payment Rates” The basic idea is that,...Read more
The two-midnight rule, which relies on the time a patient has been treated in a hospital, has changed the way hospitals determine when a patient transferred from another facility should be admitted and when treated as an outpatient. The rule has also impacted the status of the patient at the sending hospital.
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