Compliance & Legal
Healthcare providers can expect an increase in medical claim denials after Oct. 1, 2015. But that doesn't have to mean that revenue will be lost.
Although CMS paused the RAC audit program in March, hospitals must remain vigilant. The agency has promised a new round of recovery auditor contracts will be awarded before the end of 2014.
The Medicare Payment Advisory Commission discussed last week the option of creating specific Diagnosis-Related Groups for one-day hospital stays, in an effort to reduce payment differences between short inpatient and similar outpatient hospital stays.
Defying expectations, the court announced last week it has agreed to hear a case that challenges the heart of the Affordable Care Act: subsidies to help people pay their insurance premiums.
A recent study paints 340B program participants in a negative light, suggesting that covered entities chase profits and experience windfalls rather than help patients. However, these assumptions are far from true.
The U.S. Department of Health & Human Services Office of Inspector General has posted its FY 2015 Work Plan, which summaries OIG's intended legal and investigative initiatives in the coming year. Among other issues, OIG wants to expand its oversight of Medicare and Medicaid reimbursement.
Hospitals and health systems want to mitigate their compliance spend as much as possible, as well as reduce the odds of facing large penalties for being out of compliance. The path to lowering the costs of compliance starts with putting appropriate policies and procedures in place -- and getting the right people at the table to make that happen.
California's public health department has failed to adequately manage investigations of nursing homes statewide, resulting in a backlog of more than 11,000 complaints -- many involving serious safety risks to patients, according to an audit released last week.
More than 83 percent of physician practices do not believe current Medicare physician quality reporting programs enhanced their physicians' ability to provide high-quality patient care, according to new research released Monday.
Employment and buyout agreements are usually referred to as "governance documents" for physician practices, and there are more than just these two. But do medical practices really need such documents?