Noting that the Centers for Medicare & Medicaid Services (CMS) contractors are responsible for administering more than half a trillion dollars in Medicare benefits annually, the U.S. Department of Health and Human Services (HHS) Office of Inspector General’s (OIG’s) Robert A. Vito said Tuesday that the OIG has discovered a number of “recurring issues” that limit CMS’s oversight across all contractor types. Vito, the regional inspector general for the HHS OIG, …Read more
During the past 10 years, the RACs (Recovery Audit Contractors) have been able to recoup billions of dollars over the single issue of inappropriate or medically unnecessary inpatient admissions. For the most part, while these admissions may not have been medically necessary, some form of service (namely outpatient or observation) was fully justified. The RACs and hospitals constantly disagree relative to the propriety of inpatient admissions. Two key factors in the …Read more
Brock Slabach Relief is the best word to describe the reactions from the rural hospital community in relation to the Feb. 21 announcement by the Centers for Medicare & Medicaid Services (CMS) that recovery auditors will stop requesting medical records. Brock Slabach, vice president of the National Rural Hospital Association (NRHA), joined the March 3 Monitor Monday broadcast and shared the overall reaction of rural hospital leaders and staff in addition to …Read more
Robert Menendez Deb Fisher March 7, 2014—The widely reported Senate bill introduced yesterday for changing provisions of the controversial two-midnight rule proposes a new category of reimbursement for medically necessary short stays, but seems to offer little relief for hospitals. The bipartisan bill, “Two Midnight Rule Coordination and Improvement Act of 2014,” S. 2082, introduced by U.S. Senators Robert Menendez (D-NJ) and Deb...Read more
Although providers typically don’t encounter them as often as audits from Recovery Audit Contractors (RACs), Medicare Administrative Contractor (MAC) audits can represent a more serious revenue risk. This is because MACs can hold back payments before reimbursement—depending on the type of review. Diligent focus on the timely submission of medical record documentation is required in order to mitigate takebacks. In the...Read more
Every year governing boards (GB), CEOs, and other hospital leaders gear up for the annual strategic planning process. There is typically planning for volume growth, service expansion, and cost management, all of which are crucial to a healthy hospital – but does your hospital also distinguish utilization management (UM) as a key strategic component? If not, you may be leaving...Read more
The recent announcement by the Office of Medicare Hearings and Appeals (OMHA) that it will delay assigning an administrative law judge (ALJ) to any new audit appeals for two years has providers up in arms, and understandably so. Yet the ALJs also have cause for complaint. The ALJ governance structure was never designed to receive and process so many appeals. Per...Read more
Tuesday, March 18, 2014, 1:30 p.m. to 2:30 p.m. (Eastern Time)
Hospices are in the crosshairs. The OIG has set its sights on hospice care in its annual work plans with increases in the number of audits. Fraud and abuse surveys point to a heightened scrutiny of the medical necessity of hospice services—especially admission practices, location of services, inpatient status, and relationships with skilled nursing facilities. Plus, there are more regulations...
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