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Always challenge the extrapolation. It is my opinion that extrapolation is used too loosely in healthcare audits. What I mean is that sample sizes are
Two key insurers were recently targeted for HHS OIG scrutiny. I was all set to dive into the September audits of HumanaChoice and BlueCross Blue
Quality reporting will be mandatory in 2024, and then under a payment determination in 2026. Last week I reported on the social determinants of health
A close look at three extrapolation case histories. When the COVID-19 pandemic first hit in 2020, many folks assumed that it would not be an
There are 50 Shades of Grey in federal prepayment review. I hate wishy-washy laws. If a law exists, in my mind, it should be specific.
Well, it appears I opened a real can of worms last week when I mentioned a DRG downgrade audit finding received by a hospital for
The updated guidelines, developed jointly by AHIMA and ACDIS, are expected to be announced today. The American Health Information Management Association (AHIMA) is expected to
The good, the bad and the ugly in healthcare news reporting. It is time for another multi-topic update. Some weeks produce just too much news
Healthcare pricing is a complicated minefield. A recent RACmonitor article written by Govind Goyal described enforcement of the price transparency rule. At the Chicago-Kansas City
CMS has implemented two measures under its Hospital Inpatient Quality Reporting program. There is a lot of buzz in the Social Determinants of Health (SDoH)
A timely update on the NSA and the AEOB. In August, the administration published the final final rule on the No Surprises Act’s Independent Dispute
Claim denials for children 21 years of age or younger should be disputed through EPSDT. As you know, many states have expanded Medicaid. I am
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