$8.9 million. That is the amount Kentucky-based Baptist Healthcare Systems, Inc., had to pay as of September 1 to settle claims of improper billing related to respiratory infections and inflammations, pulmonary edema (fluid accumulation in the lungs), respiratory failure, and septicemia (blood...Read More »
Out of 88 claims for MS-DRG 246 (percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents with a length of stay less than or equal to two days) reviewed during a recent probe audit, TrailBlazer Health Enterprises, LCC, fully denied 65 of them,...Read More »
Being described as "worse" in a CMS HospitalCompare data file is a dubious distinction.
A recent HospitalCompare list identifies 292 hospitals with 30-day readmission rates that are the highest in the nation in at least one of three disease categories— acute myocardial infarction,...Read More »
To make up a gap in expected overpayment collections Recovery Audit Contractors may escalate audit activities in the coming months, according to an article by Vickie...Read More »
In January facilities should expect to receive Recovery Audit Contractors (RAC) demand letters not from the RAC itself but from their Medicare Administrative Contractor (MAC), according to CMS Transmittal 192...Read More »
CMS recently updated Hospital Compare web site data for 30-day mortality rates and 30-day readmissions rates for inpatients admitted with heart attack, heart failure, and pneumonia. The data shows national declines in 30-day mortality rates of 15.9% from 2007 through 2010. (Read more at...Read More »
It started with two courageous coders who knew the query process where they worked at Johns Hopkins Bayview Medical Center, Inc., in Baltimore, wasn't quite right--or compliant.
Specifically, the hospital employed a physician who worked in the billing department to review clinical...Read More »