Don’t underestimate the importance of proving medical necessity. If you’re waiting for the feds to lighten up their fraud-fighting efforts, you’ll be waiting a long time. A new report highlights audits and investigations — and the numbers are staggering. In [...]
Report highlights importance of medical necessity. If you’ve ever wondered whether the U.S. Department of Health and Human Services Office of Inspector General (OIG) collects on its audits and investigations, a new report answers that question — and the numbers [...]
Question: In your previous issue, there was an article about how the OIG downcoded a claim in which the ED made the decision to admit a patient to the hospital ("This ED Error Is Among CMS's Examples of How Not to [...]
OPPS conversion factor drops, but individual APC payments changes will vary. The Centers for Medicare and Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System (OPPS) Final Rule on Nov. 30, 2015, effective for dates of service on and [...]
ED Facility Levels Don’t Collapse, But More Facility Payment Bundling Will Occur In 2015 The 2015 Hospital Outpatient Prospective Payment System (OPPS) Final Rule was published in the Federal Register on November 10, 2014 and govern services provided beginning with [...]
Plus: Be ready for ICD-10 testing this week. If you collected $8.10 every time you spent a dollar, you’d ramp up your efforts to spend and collect more, right? That’s the logic that the Department of Justice (DOJ) is using [...]
You can expect the Department of Jus-tice to keep the heat on Medicare providers. "The Justice Department’s Medicare Fraud Strike Force has set record numbers for health care prosecutions in Fiscal Year 2013," the DOJ crows in a release. "The [...]
Test yourself by choosing the proper codes and units for this encounter. Finding the proper codes -- even for well-documented visits -- can require some detective work. Take a look at the sample scenario and make your choices for the appropriate ICD-9-CM, [...]
Even if you aced our 99211 quiz on page 234, it's a good idea to brush up on some basic facts about using 99211. Keep the following in mind when you report this level one office visit code:It's not just [...]
Hospices with lots of nursing home patients are suspicious, new OIG report says. You may have to think long and hard about furnishing hospice services to nursing home patients if a new recommendation by the OIG gets adopted. In a [...]
