Tammy Combs, RN, MSN, CDIP, CCS, CCDS, will present “How to Mitigate and Manage Denials,” on Day 2 of the ACDIS conference. Combs is the director of HIM practice excellence, CDI/nurse planner at AHIMA in Chicago, Illinois....Read More »
Rush University Medical Center in Chicago did not comply with Medicare billing requirements for 57 inpatient and outpatient claims reviewed by the OIG, according to the OIG’s November report. According to the report, this...Read More »
Q:Our facility does not have a standard appeal letter template to respond to medical necessity denials. Do you have any suggestions for how to respond? Read More »
The improper payment rate for hospital outpatient services for the 2016 CERT report period was 5.4%, at a projected cost of $3.1 billion, which accounts for 7.5% of the overall Medicare fee-for-service improper payment rate.Read More »
Formerly known as Recovery Audit Contractors, the Tax Relief and Health Care Act of 2006 created Recovery Auditors to identify Medicare overpayments and underpayments made on claims of healthcare services provided to Medicare beneficiaries.Read More »
Before the first word of an appeal is ever written, review the denial chart thoroughly with the hospital’s appeal response ream. An appeal response team does not need to be big and certainly should not follow the usual constraints imposed...Read More »
Q:How does the Supplemental Medical Review Contractor (SMRC) determine which reviews to perform? Does SMRC work for CMS or our Medicare Administrative Contractor (MAC)? Read More »
