Recovery Audit Contractors (RAC) denied $86 million in claims in 2010—more than double the $42 million reported in the third quarter. Medically unnecessary services accounted for 57% of the denials, with 33% of these for short stay patients, according to the American Hospital Association’s (AHA...Read More »
Clarifying hospital-acquired conditions (HAC) and present-on-admission (POA) conditions represent just two additional aspects of medical record inspection CDI specialists are frequently asked to perform. Determining whether a condition was actually POA and not a HAC helps coders sequence...Read More »
The Department of Health and Human Services (HHS) called it the largest healthcare fraud sting in history. On February 17, the Medicare Fraud Strike Force charged 111 defendants in nine cities, including doctors, nurses, healthcare company owners and executives, and others, for alleged...Read More »
If the data is true, the population of a couple of concentrated areas in California suffer from kwashiorkor syndrome, a type of malnutrition typically seen among children in third-world countries, according to...Read More »
A recent special edition MedLearn Matters article SE1028 outlines four risk areas targeted by the recovery audit contractors (RACs). Of particular concern, according to William E. Haik, MD, FCCP, a pulmonologist and director of DRG Review, Inc., in Fort...Read More »
Despite the guidance CMS offers about proper inpatient admission decisions, hospitals still struggle with the process. In order to clear up confusion CMS issued a special edition MLN Matters article that includes excerpts...Read More »
As announced in the January 20 issue of CDI Strategies, CMS issued a proposed rule to establish a new Hospital Inpatient Value-Based Purchasing (VBP) program slated to take effect October 1, 2012 (for Fiscal Year [FY] 2013). CMS will hold a special open door forum on Thursday, February 10...Read More »