Not medically and reasonably necessary. Records not submitted. Lack of inpatient admission orders. Information submitted doesn’t support the services supplied for the dates billed.
These four, seemingly simple, reasons represent the top denials for Palmetto GBA, Medicare Administrative...Read More »
Since the Institute of Medicine’s November 1999 report “To Err is Human,” a new mantra regarding the structure of healthcare delivery and reimbursement emerged. Today, government reimbursement methods increasingly focus on pay-for-performance, pay-for-quality measures, and strict adherence to...Read More »
After a decade of performance-based healthcare payment initiatives, the Department of Health and Human Services decided it was high-time to take a look at the success of those initiatives even as it embarks of additional value-based purchasing (VBP) measures across an array of healthcare...Read More »
Volunteers sought for ICD-10-CM/PCS end-to-end testing set to begin in July. The tests will demonstrate whether CMS systems including Medicare claims, MACs, and the Common Electronic Data Interchange (CEDI) contractors are ready for the ICD-10 implementation.Read More »
In 2008, only 11% of poll respondents indicated their CDI program either reviewed outpatient records for documentation improvement opportunities or were looking to expand into outpatient (8% and 3% respectively). How has the climate changed?
From calendar year 2008 to 2011, Medicare paid more than $65 billion for physician services. In each of these years, 2% of the physicians were responsible for almost 25% of all the payments—each receiving annual payments of approximately $1 million, according...Read More »
