Incorrect inpatient rehabilitation facility (IRF) claims led to $444,458 in overpayments at Memorial University Medical Center, a Savannah, Georgia-based hospital, according to a recent Office of Inspector General audit report. IRF billing compliance has been on the OIG’s radar for several years, and Medicare Administrative Contractors and supplemental medical review contractors have been placing these claims under increased scrutiny.
Mr. A suffered a cerebrovascular accident, which has affected his ability to comprehend and communicate. Mr. A needs someone to consent for percutaneous endoscopic gastrostomy placement, but he lacks the capacity for decision-making, as certified by two physicians.
Healthcare organizations are facing challenging times. Shifting reimbursement models and the uncertainty surrounding federal programs may cause organizations to tighten their spending. Every department—from clinical to security—can feel the pinch as leadership prepares to weather the bumpy road ahead.
A recently identified form of malware affecting Android devices can copy files, saved Wi-Fi network information, and record full phone calls. The copied data is uploaded to a cloud server.
Q: We are trying to educate our coding department about medical necessity, but has CMS or Medicare defined it anywhere? How can we explain it to staff?
