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. Looking ahead we have a preview of tomorrow’s edition of Monitor Monday.


Skilled nursing facilities (SNF) continue to be a trending story these past two weeks. RACmonitor editorial board member broke the story March 10, 2016 when he reported that the Centers for Medicare & Medicaid Services (CMS) had authorized the Recovery Auditors (RAs) to audit these facilities. Then on March 15 — the Ides of March —Mark McDavid, president of Seagrove Rehab Consulting + Education, wrote the first of two stories on the impact that the CMS directive is likely to have on SNFs. His latest story was published by RACmonitor this past Thursday as you’ll note in this edition where we have provided links to all of Thursday’s news stories. 

Finally, on Friday, April 1, Fool’s Day, former ALJ Bob Soltis sent the following news bulletin. In a follow up phone call to me on Friday afternoon he told me that someone actually “fell for the story.” Here’s what Soltis sent to his followers:

RAC Program Cancelled

Acknowledging what critics of the Recovery Audit Program have been saying for years, the Center for Medicaid and Medicare Services announced on April 1 that it would end the unpopular program.

In a news update that was kept surprisingly secret until its Friday morning release, the acting CMS director said “At best, the RAC program was a shell game; at worst it simply failed the taxpayers in two ways – spending far more money than justified by its less than stellar recovery for the taxpayers, and it did a further disservice to the public because the RAC program set the stage for a tidal wave of appeals that swamped the entire Medicare appeal system.

Officials also suggested that heretofore unseen ethical rules would be applied to medical directors at CMS contractors, requiring them to testify truthfully and cite policy correctly during administrative hearings. Friday’s announcement included plans for immediate ethics audits of the notorious own motion review program at the Administrative QIC. 

While not stated in so many words, officials hinted that refunds of all monies recuperated under the program would begin on February 31, 2017. 


A therapy provider, asking Tim Powell a question about therapy minutes in his article, writes: “I have learned from RACMonitor there is a difference between thinking and knowing, inference and fact, and the spirit and the letter of the law.”

In response to last Thursday’s article written by Ronald Hirsch, MD, “Compliance Double Speak Must Cease,” a reader acknowledges why payers are not so inclined to cease: “…but they never will. It is to the advantage of a plan, any plan, Medicare, Medicaid, BCBS and so on to be ambiguous in all the rules. Very unfair but the way it’s been for years and unlikely to change. It doesn’t have to be complicated.”


Starting April 1, rural health clinics are to start using Current Procedural Terminology® (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes in filing their claims. While this may seem fairly straightforward, the Centers for Medicare & Medicaid Services (CMS) is having a difficult time in making decisions about correct coding and billing in this area. We’ll have a special bulletin on this subject on Tuesday. 


Revenue from Surgery: Learn How to Optimize Revenue Integrity Compliantly

Thursday, April 14, 2016  |  1:30-2:30 PM ET 

Could revenue from surgery at your facility be at risk? Risk-prone factors surrounding surgical procedures conducted at your facility could pose serious compliance issues. Learn how to protect your facility’s revenue from surgery. Ronald Hirsch, MD, FACP, CHCQM, vice president of Accretive Physician Advisory Services, will lead this 60-minute webcast. 

“You Have 60 Days to Come Clean”

Tuesday, April 26, 2016  |  1:30 p.m. ET 

CMS published a final rule detailing the duty of providers to report and return overpayments within 60 days of their identification. Congress adopted the “report and return” requirement as part of the Patient Protection and Affordable Care Act. Healthcare attorney David Glaser will guide attendees through the labyrinth of regulations. Consider this to be a must-see webcast.


Creating Healthier Rural Communities

Rural healthcare authority Janelle Ali-Dinar, PhD, is producing a webcast for RACmonitor readers on the state of rural. The presentation will address rural precision medicine, advanced diagnostics and population health methods/services of treatment to bridge the gap of care for the most critical needs of rural populations including chronic disease management, opioid abuse and medication management and premature deaths.

Thursday, May 12, 2016  |  1:30-2:30 p.m. ET

Understanding Your When Being Audited

Demand letters imply a rock-solid scientific approach was used in the statistical work. But that is usually false. Providers have legally guaranteed rights to examine all aspects of an audit, including the sampling and extrapolation, according to Edward Roche in describing his upcoming webcast. 

 Wednesday, May 25, 2016  |  1:30 -2:30 pm. ET.

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