After releasing its General Compliance Program Guidance in 2023, the Office of Inspector General (OIG) is continuing to deliver supplemental guides geared toward specific subsectors of the healthcare industry....Read More »
CMS recently revised Chapter 4 of the Medicare Claims Processing Manual to provide Method II critical access hospitals (CAH) with updated billing requirements for professional emergency services performed in the...Read More »
Kaiser Permanente has reached a settlement agreement with the United States Department of Justice over documentation practices impacting some Medicare Advantage (MA) risk adjustment payments from 2009‒2018. According to the Office of Inspector General (OIG)...Read More »
Medicare would’ve saved over $300 million if CMS’ bundled payment rates for opioid use disorder (OUD) treatment services had reflected the types and frequency of services actually provided to enrollees, according to a recent Office of Inspector General (OIG) ...Read More »
Year after year, sepsis is a common problem diagnosis for the CDI profession when it comes to missed opportunities and common denials, not to mention a deadly diagnosis for patients. This year, more than 85% of respondents in the...Read More »
Q: Does anyone have experience with denials based on the Global Leadership Initiative on Malnutrition (GLIM) versus the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria?
Response #1: First, as to criteria, it should...Read More »
