CMS Sets Sights on MA Plans
Mark Spivey
February 1, 2023
The federal agency announced this week that it has updated its policies for the MA RADV program. Echoing an intensifying drumbeat of criticism heard from
The federal agency announced this week that it has updated its policies for the MA RADV program. Echoing an intensifying drumbeat of criticism heard from
OIG claims 25% of Medicare beneficiaries experienced adverse effects during their hospitalization in October 2018. As usual this week I want to write about a
Providers need to be proactive when defending against RAC and MAC audits. The Recovery Audit Contractor (RAC) program was created through the Medicare Modernization Act of
One cannot place liability on the patient without a safe discharge plan in place. Case management takes on many roles within the hospital setting, but
CMS is simply proposing to codify what is currently CMS policy. I was wrong. There, I said it. And I extend a heartfelt apology to
It’s sometimes better, sometimes worse for the provider. The Medicare Program Integrity Manual (PIM) over the years has undergone a number of changes. Here, we
CMS proposes new rules for 2024 that apply to Medicare Advantage Plans. Last month, I told you that there would be big news coming, and
The OIG claimed that 71 of 333 inpatient claims did not meet Medicare criteria for inpatient status. A recent report, titled “CMS Can Use OIG
New deductibles and payment rates lead to new patient financial obligations for 2023. EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor
Proposal also seeks to increase information to patients. New proposals to improve the prior authorization process, while giving patients information on the status of prior
Nursing suffers disproportionately. Are Medicare auditors similar to ancient hunting parties, roaming the tundra for wild game? Are audits applied equally and randomly across all
A longtime RACmonitor contributor has three different topics on his mind this week. Let’s start with the good news. It looks like we will be
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
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