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 »
Cedars-Sinai Medical Center in Los Angeles receives nearly $300 million in Medicare “outlier” payments—more than any other hospital in the country, according to a Modern Healthcare analysis of data provided under a Freedom of Information Act request published in its November 23 article...Read More »
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 issued new guidance last week aimed at clarifying the so-called “two-midnight rule” finalized in the 2014 IPPS. The rule essentially states that physicians should order an inpatient admission if he/she expects the care...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 »
When CMS stopped paying for healthcare-associated infections such as catheter-associated blood stream infection and urinary tract infections, the agency expected rates for such infections to decline. In fact a recent study “found no evidence that the 2008 CMS policy had any measurable effect on...Read More »
Q: What are the ramifications of leading queries? Who is monitoring whether a query is leading?
A: I am unaware of any organization or agency routinely monitoring physician queries. However, regular query review for compliance with existing industry guidelines, reflection of appropriate...Read More »
