Reducing mistakes and eliminating fraud are the dual goals in today's claims auditing environment. While these goals are admirable, the aggressive strategy typically executed by Recovery Auditors and other auditing agencies to achieve those goals is fundamentally...Read More »
The American Hospital Association threw its support behind proposed legislation that would delay enforcement of the ‘two-midnight’ rule. Originally included in the 2014 IPPS Final Rule, the regulation changes the definition of medical necessity for...Read More »
The federal court houses are closed. So are national landmarks, the United States scientific excursions to Antarctica, and there’s even talk about it hurting craft beer makers. Yes, even some CMS offices will close.
In two recent findings from the Office of the Inspector General (OIG), improper documentation may have led to inaccurate claims submission and associated payments....Read More »
CMS has been releasing ICD-10 National Coverage Determination (NCD) “omnibus” transmittals since September 2012, which gives providers some information about CMS’ coverage policies moving forward. NCDs are only part of the picture. On September 6, CMS...Read More »
Although Recovery Auditors have identified more than a billion dollars in inappropriate payments, CMS needs to do more to improve its oversight of the program, and target potential instances of fraud identified by the program,...Read More »
