More than $620 million should have come out of hospices’ pockets, audit claims. It’s not just Medicare that is putting payments for non-hospice services to hospice enrollees under the microscope. The Massachusetts Office of the State Auditor audited claims paid [...]
It’s not just Medicare that is putting payments for non-hospice services to hospice enrollees under the microscope. Massachusetts Office of the State Auditor audited claims paid by MassHealth for dual-eligible members who were receiving hospice care from January 2015 through [...]
Plus: Skyrocketing utilization shows one reason why the industry is singled out for scrutiny. Don’t be surprised to see Medicare start putting certain diagnoses on the no-code list for hospice patients. In the rule published in the April 14 Federal [...]
Plus: For-profit hospices continue to proliferate, to CMS’ apparent chagrin. Hospices have been able to keep up with industry statistics thanks to the Medicare Payment Advisory Commission’s annual report to Congress, but Medicare’s new hospice proposed rule signals action may [...]
Question: The physician saw an inpatient with chronic lymphocytic leukemia who was admitted with tumor lysis syndrome due to chemotherapy and then developed SIRS related to the cancer and resulting in acute kidney failure and acute respiratory failure. How should [...]
Be careful to document all "present on admission" conditions for each patient. While the Inpatient Prospective Payment System (IPPS) has not been overhauled for 2013 by the Centers for Medicare & Medicaid Services (CMS), you’ll need to be on your [...]
Plus, you’ll have additional personal history V codes for next year. In just a few months, you’ll be faced with more than 350 ICD-9 changes. If you don’t incorporate the changes into your coding that day, your practice could face [...]
Tip: Pay special attention to qualifying secondary dx for SSI following CCID. CMS didn’t overhaul its MS-DRG methodology or other areas of the Inpatient Prospective Payment System (IPPS) for 2013, but every hospital still needs to pay attention to the [...]
Question: I have trouble distinguishing between sepsis, septicemia, and similar conditions. Could you explain what septic shock is? Answer: The term "septic shock" generally refers to circulatory failure associated with severe sepsis, so it represents a type of acute organ [...]
But home care audits are relatively few.The Government Accountability Office continues to highlight home care fraud in front of Congress. In testimony before two congressional committees, the GAO pointed out home care fraud-related activities.On June 8, the GAO's Kathleen King [...]
