Imagine you are listening to a lawyer making a presentation. The lawyer says something that is totally contradictory to everything you have heard before. What should you do? How do you decide what information is correct? The first thing to remember is that for many of us, myself included, there is a tendency to place greater credence on the first piece of information you hear. I know that if the first …
Read moreIn a twist of irony only to be expected in the Recovery Audit program, the Medicare Administrative Contractor (MAC) for six Midwest states is not prepared to accept Part A-to-Part B re-bills. As reported to RACmonitor last week by McLaren Greater Lansing Hospital Compliance Audit Coordinator Sandra Palmer, Wisconsin Physicians Service (WPS), the MAC for J5 (including Iowa, Kansas, Missouri, and Nebraska) as well as J8 (including Indiana and Michigan) is …
Read moreIt is the ultimate goal of any case management team to facilitate the delivery of high-quality care in a cost-effective manner, and to promote positive healthcare outcomes. Hospital case management is episodic by design and typically focused on the acute, emergent or elective clinical care required for the patient upon arrival. The hospital environment itself is unique, as it features a host of professionals and practitioners with expertise across multiple fields, …
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Outpatient Therapy and the Advanced Beneficiary Notice of Non-Coverage Have you been issuing blanket ABN notices to therapy outpatients when they reach the $1,900 therapy cap ($1,900 for physical therapy and...
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The Region A RAC, Performant, posted a semi-automated review issue on April 25, noting that it is targeting all of Region A with regard to procedures performed in the post-operative...
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In 2012, the American Hospital Association (AHA), along with several hospitals across the country, filed a lawsuit in federal court to put a stop to the Centers for Medicare &...
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We have seen numerous articles about growing frustration among hospitals related to denied inpatient claims and the increasing use of observation status. The challenges continue to grow with the new...
Read moreChuck Buck | 03.22.2013
Dust continues to settle following Tuesday’s re-introduction of the Medicare audit reform bill (HR 1250) in the U.S. House of Representatives by Rep. Sam Graves (R-Mo.) and Rep. Adam Schiff...
Read morePRGX Global, the RAC contractor formerly known as PRG-Schultz, whose 2008 protest of the awarding of…
With Recovery Audit Contractor (RAC) audits in full swing, many healthcare providers are entrenched …
A look at the pathology and laboratory section of the 2013 CPT code book reveals a lot of green text…
One provision in the American Taxpayer Relief Act of 2012, perhaps better known as the “fiscal cliff…
Janis Oppelt | 05.02.2013
When Daniel Levinson, the Department of Health and Human Services Inspector General (IG), took the stage at the recent Healthcare Compliance Association (HCCA) conference in "our nation's capital," he compared...
Read moreOn March 26, the Office of Inspector General of the U.S. Department of Health and Human Services (OI…
Improper funding of contracts, inconsistencies in grant management and alarming violations of health…
Washington, D.C.—Recognizing that the Centers for Medicare & Medicaid Services (CMS) had collect…
Ralph Wuebker, Chief Medical Officer | 04.18.2013
On March 13, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-1455-P) addressing Part B inpatient rebilling in hospitals, and the agency is seeking public comment....
Read moreConsidering the increasing scrutiny of Inpatient Rehabilitation Facilities (IRFs) under Recovery Aud…
Tuesday, May 28, from 1:30 p.m. to 2:30 p.m. ET
What’s the true cost of blood? Whatever you estimate, it’s likely to be higher – and it is certainly high enough to stand out as a RAC target. According to a recent study, actual blood transfusion costs range between $522 and $1,183 per unit. Then add all the associated costs and a potential three to five-fold higher than reported blood acquisition costs, and you’re talking significant dollars.
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