“Medical necessity” is generally understood to refer to the requirement that medical services be justifiably reasonable, necessary and appropriate and is inextricably linked to the modern phenomenon of payer-based healthcare. But there’s no universally accepted definition of the term, and providers, private payers, CMS and More..
A medical practice’s coding and billing accuracy has never been more critical to its financial survival. The Medicare Access and CHIP Reauthorization Act (MACRA) requires medical practices to submit specific data to meet value-based payment requirements. And the rise of high deductible health plans (HDHPs) More..
Speculation about how the FDA will change under the Trump administration is top-of-mind for every pharma professional today. Everyone from regulatory affairs personnel and product safety managers to marketing folks and compliance experts are wondering what’s next. Two of the main issues are how Trump’s More..
The Department of Health and Human Services is continuing to develop its HIPAA audit program. After conducting trial audits and a second round of audits in 2016, including those of HIPAA business associates, HHS has indicated that the HIPAA audit program will become permanent. Meanwhile, More..
Observation services are one of the most challenging areas that hospitals face. Physicians must document carefully in order to justify observation services, but it’s not always easy to know what should be documented at the time patients are discharged from such services. Observation must be More..
Most physicians understand the importance of documenting services effectively and yet still miss crucial elements while documenting services. To ensure proper reimbursement, physicians, coders, office managers and auditors must understand the major physician documentation issues that affect reimbursement. Some of the problem areas physicians can More..
Grievances and Complaints: What Hospitals Should Know About the CMS and Joint Commission, DNV Standards and OCR
The CMS grievance requirements are a frequent source of investigation, and CMS perennially identifies them as problem areas for hospitals. Therefore, it is important to understand why all hospitals that receive reimbursement for Medicare patients need to follow the CMS conditions of participation on grievances. More..
Standing orders and Medicare conditions of participation that relate to them are some of the most confusing compliance requirements that hospitals face. Both CMS and the Joint Commission address this tricky area, and four separate sections of the hospital CoP manual regulate the issue of More..
The federal government is reducing payments to hospitals that readmit too many patients, but improving your facility’s discharge process can help you avoid payment reductions. Staying on top of the latest programs and regulations from the Centers for Medicare & Medicaid Services (CMS) is crucial More..