There may be hope for hospitals carefully watching the proposed IPPS rule, praying for some amelioration of the suggested 2.9% documentation and coding adjustment (DCA) it included. On July 12, 242 members of Congress...Read More »
A special edition MLN Matters article released last week points to two common reasons for RAC claims denials—lack of timely submission of requested documentation and lack of documentation supporting medical...Read More »
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) includes a wealth of information regarding MS-DRG outliers that might otherwise go completely unnoticed. That’s what happened at Baptist Memorial Health Care Corp. until the 15-hospital health system began analyzing its...Read More »
Despite the inclination of many hospital administrators to mechanize documentation and abstraction of quality measures, Kristen Geissler, MS, PT, MBA, CPHQ, associate director in the Healthcare Clinical Economics Practice at Navigant Consulting, Inc., in Baltimore, hasn’t heard of anyone able to...Read More »
The Government Accountability Office (GAO) offered mixed reviews of CMS’ handling of the Recovery Audit Contractor (RAC) demonstration program, according to a report released March 31. While the...Read More »
Q: I have been dealing with a denial issue where, because a chest x-ray did not show pneumonia and a repeat x-ray was not performed, the pneumonia was denied. In dehydrated or immunocompromised patient the chest x-ray may not initially show the pneumonia. I am now looking for supporting...Read More »
In 2008, the Office of Inspector General (OIG) reviewed a sample of nearly 300 Medicare hospitalizations from two counties in a one-week period in order to analyze current methods of identifying adverse events in hospitals. According to a report released this month, vulnerabilities exist in...Read More »
