Inpatient admissions for patients undergoing cardiovascular procedures such as implants of stents and pacemakers and elective kyphoplasty procedures appears to be the culprit behind a $37 million dollar False Claims Act settlement between the government and Dignity Health,...Read More »
As the adage goes “a picture’s worth a thousand words” but for facilities wrangling with the Office of the Inspector General (OIG) the adage might better be rephrased to “a sample’s worth a million dollars,” as the agency extrapolates payment errors to the sum of more than $400,000 related to...Read More »
After announcing its intention to essentially cut a deal with hospitals in order to settle a backlog of pending denials’ appeals, it now appears that CMS may not have the authority to do so, according to a letter to HHS Secretary Sylvia Burwell...Read More »
by Shannon Newell, RHIA, CCS, Steve Weichhand, and Sean Johnson
Since the implementation of the Hospital Value-Based Purchasing (HVBP) Program in 2013, CMS has adjusted the MS-DRG payment for each traditional Medicare discharge. The type and amount of the adjustment, which could...Read More »
We’re less than six weeks away from our annual conference! As the countdown continues, we’re previewing a handful of speakers to give you a feel for the educational sessions being offered. This week, we spoke with Lynn H. Lowery, CPC, CFPC, who, along with Trey A. La...Read More »
Due to the continued delay in awarding new Recovery Auditor (RA) contracts, CMS made modifications to the current RA contracts allowing them to restart some reviews. Most will be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS. In the meantime,...Read More »
