Due to the continued delay in awarding new Recovery Auditor (RA) contracts, CMS made modifications to the current RA contracts allowing them to restart some reviews. Most will be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS. In the meantime,...Read More »
Of all the Recovery Auditor denials, hospitals reported appealing about 50% with more than a 50% success rate—it’s 50/50 game that hospitals cannot afford to not play, according to the American Hospital Association’s recent RACTrac...Read More »
In the first half of the 2014 fiscal year, the Office of the Inspector General (OIG) reported more than $3 billion in audit recoveries, nearly $3 billion recovered from investigations, and nearly a million in other non-Department of Health and Human Services (HHS) investigations due to efforts...Read More »
As more facilities face the specter of reimbursement losses related to the Readmission Reduction Program, CDI programs may be asked to take a second look at records to help ensure documentation is adequate to fully support the patient’s diagnoses, says Susan Wallace, MEd, RHIA, CCS, CCDS...Read More »
Physician evaluation and management (E/M) payments cost Medicare $32.3 billion in 2010—about 30% of all Part B payments that year—and of that amount, about $6.7 billion were incorrectly coded or documented, according to an Office of...Read More »
Oakwood Hospital and Medical Center (the Hospital), in Dearborn, Mich., is the latest facility to fall under the sights of the Office of the Inspector General (OIG) for inappropriately assigning diagnosis code 260 for Kwashiorkor.Read More »
