RAC Hit’s Region C for Incorrect Billing of Hydration Therapy

Outpatient hospital services for hydration therapy have been approved for automated review. The issue for review is due to incorrect billing of hydration therapy with diagnosis codes that are not considered reasonable and medically necessary per the applicable Local Coverage Determination (LCD). Novitas Region C states will be affected. If your facility is in this … [Read More]

Risk Mitigation in Today’s Healthcare Environment

The Critical Role of Analytics in Managing the Strategic Decision Process By Jack Duffy Executive Vice President   We have all heard the expression “Betting the farm” – farmers understand that a poor decision on diversifying crop selection, planting dates, water and weather can determine the success and future of their farm. The significance of … [Read More]

The 2014 OIG Work Plan Has Arrived!

The Officer of Inspector General has finally released the 2014 work plan!  Some of the areas of interest for hospitals are as follows: Reconciliations of Outlier Payments In the area of Policies and Practices, the OIG will review the Medicare outlier payments to hospitals in order to determine whether CMS performed the necessary reconciliations in … [Read More]

Take Steps to Insure Two Midnight Rule Compliance

The two midnight rule affects both outpatient/observation and inpatient status. It is designed to limit the use of observation status for Medicare patients, which results in higher out-of-pocket costs for Medicare beneficiaries. The 2014 Inpatient Prospective Payment System (IPPS) final rule, published August 2, 2013, established new requirements for coverage of Medicare Part A inpatient … [Read More]

NCD for Cardiac Pacemakers

On February 12, 2014, the Centers for Medicare and Medicaid (CMS) published MLN Matters Article # MM8525 regarding the revised National Coverage Determination (NCD) on single chamber and dual chamber permanent cardiac pacemakers. This NCD, 20.8.3, concludes that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of … [Read More]

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