Congress expected to intervene, as before “Without congressional action, physician payments will be slashed 25% with the first cut of 23% beginning Dec. 1,” Cecil Wilson, president of the American Medical Association, said in a prepared statement. CMS issued a final rule on Nov. 3, and announced that payment rates were scheduled to be reduced […]
CMS announces education effort to support program The Centers for Medicare & Medicaid Services (CMS) today [Friday, November 5, 2010] proposed new rules to help states reduce improper payments for Medicaid health care claims through the use of Medicaid Recovery Audit Contractors (RACs) as part of the Affordable Care Act’s larger strategy to crack down […]
GlaxoSmithKline to Plead Guilty & Pay $750 Million from the Department of Justice Press Release: SB Pharmco Puerto Rico Inc., a subsidiary of GlaxoSmithKline, PLC (GSK), has agreed to plead guilty to charges relating to the manufacture and distribution of certain adulterated drugs made at GSK’s now-closed Cidra, Puerto Rico, manufacturing facility, the Justice Department […]
Audits of Electronic Health Records Cloning Reveal Documentation Problems That Put Compliance at Risk Electronic health records (EHR) are a double-edged sword. They can reduce the time it takes physicians to document patient encounters, allow real-time access to medical records and promote legibility. But CMS and Medicare contractors are wary of classic EHR physician documentation […]
Posts 25 of the Same 29 MSDRGs Already on CGI, HDI, Connolly DCS Healthcare posted approvals today for 225 DRG Validations, plus medical necessity review for 25 of the same 29 MSDRGs already approved earlier this month by the three other Recovery Audit Contractors (RACs). DCS, the RAC for CMS Region A, chose to post […]
First Requests for Maximum Records Seen Connolly Healthcare requested the maximum allowable number of records from many facilties in their region over the past few days, sending out Additional Documentation Request (ADR) letters immediately after posting approval for medical necessity review of 29 MSDRGs on August 30. The targeted facilities have never before seen requests […]
Largest Ever Jury-granted Award for Damages in America A jury returned a $677 million judgment against Skilled Healthcare Group, Inc. in a more than four-year-old class action lawsuit alleging that the company violated state mandated nursing coverage requirements in 22 of its nursing facilities over a six-year period, on Tuesday, July 6, 2010. At issue […]
[The following is the complete text from a CMS News Release, July 7, 2010.] IMPORTANT NEW DATA ADDED TO HEALTHCARE.GOV TO HELP AMERICANS UNDERSTAND THE STATE OF QUALITY AT AMERICA’S HOSPITALS Centers for Medicare & Medicaid Services’ Hospital Compare Tool Compares Outpatient Care and Inpatient Mortality and Readmissions at More Than 4,700 Hospitals Across […]
Enabling More Programs Like Recovery Audit Contractors The following documents from the White House website direct all federal departments and agencies to “expand and intensify their use of payment recapture audits under their current authority.” President Obama Announces New Effort to Crack Down on Waste and Fraud Presidential Memorandum Regarding Finding and Recapturing Improper […]