ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC DRG Code 282

Pay attention to new rule’s provision on leave related to hybrid school schedules. A new Department of Labor regulation addresses other sections of FFCRA invalidated by the New York federal court. The DOL Wage and Hour Division spends a good [...]

Comparative Billing Reports coming out. Exactly which home health agencies and claims will be subject to TPE is still unclear, but one MAC has identified the first batch of hospice claims that will go under the review microscope. The Centers [...]

SMART FACTS replaced with SIRS. The Centers for Medicare & Medicaid Services (CMS) has an able partner in its fight against fraud and abuse — the Senior Medicare Patrol (SMP). These volunteers are vigilant about uncovering Medicare and Medicaid abuse [...]

The Senior Medicare Patrol continues to make strides and recoveries. Since its formation in 1997, the Senior Medicare Patrol (SMP) has been a boon to CMS with recoveries totaling over $117.6 million. The SMP volunteers, made up of retirees and [...]

HHAs serving chronic populations will suffer under VBP, commenter said. Many providers and industry reps wrote to CMS, expressing their concern about the lack of stabilization measures included in the proposed Value-Based Purchasing model (see story, p. 282). One agency [...]

Senior Medicare Patrol recovered $9.1 million last year. Various types of government agents evaluate Medicare fraud, including attorneys, federal employees and audit contractors. However, not every person checking for fraud is a government entity — in fact, some of them [...]

$9.1 million record recovery by SMP gives you more reason to be wary. Not every person checking for fraud is a government entity. Watch out: Your very own Medicare patients, who are eligible to join the Senior Medicare Patrol (SMP), [...]

Seniors volunteer for this program, which aims to help CMS detect issues that might constitute fraudulent billing or coding trends. Various types of government agents evaluate Medicare fraud, including attorneys, federal employees and audit contractors. However, not every person checking [...]

Include hematological findings to bolster claims for services. When pulmonologist diagnoses a patient with Acute Chest Syndrome (ACS, 517.3), you will reap the best benefits if you not only know how to code the signs and symptoms but also such [...]

Bone up on OASIS accuracy to help soften the blow. Despite hearty protests from the industry, CMS has slashed 170 diagnosis codes from the prospective payment system case mix calculation for 2014. Get the Background on the Cuts Last summer, [...]