Compliance & Legal
Many hospitals focus their efforts to mitigate risk associated with the ICD-10 transition and associate that with revenue. But what about your current risk of penalty associated with value-based purchasing and with Patient Quality Reporting System programs?
The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled, sowing animosity between health systems and the feds.
With millions of Americans on new health insurance exchange plans now responsible for high deductibles, hospitals, drug makers, insurers and regulators are entering a new frontier of payment disputes.
CMS has just released a proposed rule that would require Medicare prior authorization for certain Medicare Durable Medical Equipment items that the agency characterizes as "frequently subject to unnecessary utilization." The decisions would not be subject to appeal.
With the Massachusetts Attorney General granting Partners Healthcare System a long-term lease on life as the dominant provider in Eastern Massachusetts, it's almost certain that the state and its residents will continue to pay above-average healthcare costs.
Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.
A new interpretation of a 40-year-old law could offer healthcare providers more options for appealing payer recoupments or preventing them altogether.
On Oct. 1, 2013, I marked the 12-month countdown to ICD-10 implementation by attempting to answer some basic questions. Now that more than six months have passed, and we have another deadline delay, many healthcare providers still can't get satisfactory answers.
Last week, the Centers for Medicare & Medicaid Services published a final rule that reforms federal health policy regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on healthcare providers and suppliers. Here are some highlights.
The Recovery Audit Contractor, or RAC, program is on vacation. CMS has slowed down audit activity in advance of new contracts. Still, this is no time for hospitals to get complacent about their audit management programs.