April 12, 2019
Medicare Web

CMS released a bulletin April 10 on behalf of HHS seeking providers to participate in a volunteer Provider Pilot Program to test the process for reviewing compliance with its HIPAA Administrative Simplification rules.

April 10, 2019
Medicare Web

Representatives from CMS and the Office of Inspector General (OIG) discussed hot topics and focus areas at HCCA's 2019 Compliance Institute in Boston, including developing interactive documentation checklists, potential changes to Stark Law this year, and methods to address the high rate of coding and documentation errors on inpatient rehabilitiation facility (IRF) claims.

March 1, 2019
Briefings on APCs

Many outpatient CDI professionals stepped into their roles blind—not knowing where to begin or how to tell if they were successful. However, as programs mature, they need to be able to track their progress for a number of reasons, including focusing physician education and justifying continued funding from organizational leadership.

March 1, 2019
Briefings on APCs

In the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status

February 27, 2019
Medicare Web

Community Hospital in Munster, Indiana, is disputing an Office of Inspector General (OIG) report that found DRG assignment errors and incorrect inpatient rehabilitation facility (IRF) claims, resulting in an projected $22,051,602 in overpayments.

February 1, 2019
Briefings on APCs

Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. This does not reduce the payment for the drugs, so this is an informational modifier, but it is a mandatory modifier.

January 23, 2019
Medicare Web

The Office of Inspector General (OIG) will be taking a closer look at payments for inpatient claims subject to CMS’ post-acute transfer policy, according to a recent update to the OIG work plan.

January 2, 2019
Medicare Web

Revenue integrity auditors can monitor multiple priorities more efficiently with data analytics and decision support systems.

December 1, 2018
Briefings on APCs

Follow the steps a hospital should consider when submitting a redetermination request to a Recovery Auditor.

October 31, 2018
Medicare Web

CMS is proposing to expand Medicare Advantage (MA) telehealth benefits and to increase auditing and recovery of overpayments made to MA plans, according to a proposed rule released October 26.

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