As payors both in government (Medicare) and the commercial arena (private plans) see the recoupment rate of services billed incorrectly or non-compliantly skyrocket, the payor audit is not going away anytime soon. This awareness is now producing more audits of physicians than ever before, directly contributing to higher rates of denials. Audits take time…
The U.S. healthcare system is facing a critical shortage of supplies, including ICU beds. With the rising concern over COVID-19, I decided to look at data to see what our current shortage of ICU beds could be, comparing census data in Medicare cost reports with U.S. Centers for Disease Control…
Hospitals need to submit Medicare bad debt lists on their cost reports. I was working on a project recently, reviewing bad Medicare debts for a client. I noticed a reduction for a code I do not see a lot on a claim with Medicare primary and Medicaid secondary. It was…
It’s a move sure to stir up controversy.  Under a recently passed Centers for Medicare & Medicaid Services (CMS) Final Rule, your Medicare enrollments will be judged not necessarily on your performance but based on your affiliations with other providers and suppliers. Yes, you read that right: “other providers and…
Oct. 1, 2019, marks the beginning of a new era of billing for skilled nursing facilities (SNFs). EDITOR’S NOTE: This article was published on Aug. 1, 2019, in the RACmonitor news and is reproduced today given the approaching deadline for coding compliance. Say goodbye to RUG-IV, and hello to the…
Under PDPM, reimbursement will be driven by coding and documentation. South Florida has historically been a hotbed of healthcare fraud, and there is a long list of those responsible other than Philip Esformes, who was sentenced to 20 years in prison on Thursday for fraud committed in connection with billings…
With the reimbursement so complex and antiquated, should Congress investigate? Medicare reimbursement payments to hospitals for graduate medical education are based on calculations so complicated, it boggles the mind.  The computation for direct graduate medical education (GME) payments starts with an allowable cost per resident (ARPA) determined in the early…
The Medicare Hospice Benefit proposed rule includes payment rates, wage index, and cap amount.  The Centers for Medicare & Medicaid Services (CMS) is proposing to increase hospice payments to $540 million in the 2020 fiscal year, an increase of 2.7 percent. CMS said the rate is based on the proposed…
April showers bring social determinants of health flowers The showers of April have brought a burst of blooms in the Social Determinants of Health (SDoH) reimbursement garden. First, the Centers of Medicare and Medicaid Services (CMS) released its 2020 rate sheet. As expected by the industry, Medicare Advantage and Part…
New strategy holds promise for future extensions of this technology.A medical practice can now bill and collect for a specific telehealth service without the strict rules of the originating sites being outside of a Metropolitan Statistical Area (MSA) or in a rural Health Professional Shortage Area (HSPA) located in a…