The Department of Health and Human Services (HHS) called it the largest healthcare fraud sting in history. On February 17, the Medicare Fraud Strike Force charged 111 defendants in nine cities, including doctors, nurses, healthcare company owners and executives, and others, for alleged...Read More »
If the data is true, the population of a couple of concentrated areas in California suffer from kwashiorkor syndrome, a type of malnutrition typically seen among children in third-world countries, according to...Read More »
Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to allow the initiation of post-bill queries as a result of an audit or other internal monitor. Historically we believed that a query completed after the initial...Read More »
The next quarterly conference call for ACDIS members will be held on Thursday, February 24, 1-2 p.m. ET. ACDIS members have received a phone number and password via e-mail to call into the program. ACDIS quarterly conference calls are one-hour, live telephone conferences offered as a means for...Read More »
A recent special edition MedLearn Matters article SE1028 outlines four risk areas targeted by the recovery audit contractors (RACs). Of particular concern, according to William E. Haik, MD, FCCP, a pulmonologist and director of DRG Review, Inc., in Fort...Read More »
The RACs have ramped up medical necessity reviews. Determining the medical necessity of an inpatient admission can be a complex process so we have to look at several different places for CMS guidance.
According to the Medicare Benefit Policy Manual, Chapter 1, § 10, an “inpatient...Read More »
Q: Since Acute Renal Failure (ARF) is no longer a MCC (as of October 1, 2010). I would like some input on how facilities have coped with the change. Do you just code ARF, or have you started querying physicians for more specific information such as documentation for acute...Read More »
