Welcome to the weekend and thanks for checking in. 

We’re bringing you the news from the past week as well as providing you with a look at the week ahead. And, looking ahead we have a preview of tomorrow’s edition of Monitor Mondays. 


This past Monday and Tuesday, RACmonitor produced live broadcasts originating from the Health Care Compliance Association (HCCA) annual Compliance Institute in Las Vegas. Our special guest on the 10 a.m. EST broadcast was U.S. Department of Health and Human Services (HHS) Inspector General Daniel Levinson. The Inspector General, who preferred to be called “Dan,” shared highlights of his keynote address during the broadcast. During the 3 o’clock Eastern broadcast, Deputy Inspector General for Audit Services Gloria Jarmon discussed audit cycles and the phases of an audit. You can download all the broadcasts — Monday and Tuesday —here.

We want to thank all the RACmonitor and Monitor Monday fans who stopped by the broadcast both to say, “hello.” 

Also last week, the Centers for Medicare & Medicaid Services (CMS) posted its 2017 Inpatient Prospective Payment System Proposed Rule. The proposal would impact inpatient payments under the Two-midnight rule. You can read the RACmonitor special bulletin here.


Lies, Damn Lies and Statistics

In next Thursday’s edition of the RACMonitor e-news, senior healthcare analyst Frank Cohen will report that he was working on an extrapolation audit, and noticed that the auditor took the average overpayment per claim in the sample and used it to extrapolate back to the entire population of claims within the frame. In this case, there were 18,422 claims in the frame, so even a small error in the sample would multiply to a huge potential error after extrapolation. 

Physicians, Med School Grads Becoming CDSs as Emphasis on Clinical Accuracy Grows

Allen Frady, RN, BSN, CCS, CCD, spent time recently training clinical documentation improvement specialists. He will report on some amazing discoveries while teaching at a facility in the Bronx. “I am finding more and more medical school graduates practicing clinical documentation improvement (CDI) for various reasons,” Frady writes in his upcoming article. “There is a group of medical school graduates working full-time as clinical documentation specialists (CDSs) in lieu of having completed their residency. Often that last group includes immigrants who got hung up in the red tape of making the transition to the U.S. and found practicing as a CDS the next-best way to utilize their skills and education in the healthcare environment.”  

The NOTICE Act: What is Being Accomplished?

Author, educator and consultant Duane Abbey, PhD will report on the CMS proposed new form to address the requirements from the NOTICE (Notice of Observation Treatment and Implication for Care Eligibility) Act. “Hospital compliance personnel should carefully review the proposed changes along with the discussions in the preamble of this Federal Register entry,” Abbey writes in his article scheduled for publication next Thursday. “Ostensibly,” according to Abbey, “this legislation was intended to make certain that Medicare beneficiaries know when they are in observation, that is, outpatient status versus being admitted as an inpatient.”  

CMS Launches CPC – Comprehensive Primary Care

Rural healthcare expert and RACmonitor contributing editor Janelle Ali-Dinar continues her reporting on the challenges facing rural healthcare providers. In the Thursday edition of RACmonitor e-news, Ali-Dinar has good news. She will report on the CMS plan to transform and improve how primary care is delivered and reimbursed with Medicare working with commercial payers and state Medicaid programs. According to Ali-Dinar, theexpansion of the CPC model as released on April 11, would pay a monthly fee to manage care and could impact as many as 20 regions, 5,000 practices, 20,000 physicians and 25 million patients.

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