After announcing its intention to essentially cut a deal with hospitals in order to settle a backlog of pending denials’ appeals, it now appears that CMS may not have the authority to do so, according to a letter to HHS Secretary Sylvia Burwell...Read More »
by Shannon Newell, RHIA, CCS, Steve Weichhand, and Sean Johnson
Since the implementation of the Hospital Value-Based Purchasing (HVBP) Program in 2013, CMS has adjusted the MS-DRG payment for each traditional Medicare discharge. The type and amount of the adjustment, which could...Read More »
We’re less than six weeks away from our annual conference! As the countdown continues, we’re previewing a handful of speakers to give you a feel for the educational sessions being offered. This week, we spoke with Lynn H. Lowery, CPC, CFPC, who, along with Trey A. La...Read More »
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 »
