Not medically and reasonably necessary. Records not submitted. Lack of inpatient admission orders. Information submitted doesn’t support the services supplied for the dates billed.
These four, seemingly simple, reasons represent the top denials for Palmetto GBA, Medicare Administrative...Read More »
After a decade of performance-based healthcare payment initiatives, the Department of Health and Human Services decided it was high-time to take a look at the success of those initiatives even as it embarks of additional value-based purchasing (VBP) measures across an array of healthcare...Read More »
In a letter to CMS, more than 100 members of the House of Representatives asked the agency to consider “an alternative payment arrangement with [Recovery Auditors, formerly known as RACs] to ensure RACs are not improperly...Read More »
Senate Finance, House Ways and Means, and House Energy and Commerce committees combined multiple Medicare physician payment reform proposals into one bipartisan bill titled SGR Repeal and Medicare Provider Payment Modernization Act of 2014, released Feb. 6.
I became a physician because I enjoy taking care of sick people. In today’s environment, however, I am subject to numerous unanticipated burdens that interfere with my continued enjoyment of that privilege. In discussions with my colleagues, I clearly have...Read More »
Contractors could use a little guidance from CMS to do a better job at reviewing medical records for electronic health record (EHR) problem areas. For example, clues within the progress notes, hand writing styles, and other attributes that help corroborate the authenticity of paper medical...Read More »
