Tag Archives | Medicaid

Feds Crack Down on Upcoding

By the time the late President Lyndon B. Johnson signed the law establishing Medicare and Medicaid in 1965, the health care community was already figuring out how to maximize its returns from these new programs designed to insure the elderly, poor, and disabled. Those proceeds, however, have been generated over the years in ways that […]

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CMS Told To Crack Down On Improper Medicaid Payments

The Centers for Medicare & Medicaid Services needs to step up its involvement in states’ Medicaid integrity programs in order to strengthen oversight and identify overpayments, according to a new federal watchdog report. CMS oversees how states run their Medicaid integrity programs and supports fraud-fighting efforts through reviews, training and hiring contractors to audit providers. […]

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The Opioid Payment Crisis

Addiction services may be a societal necessity – especially as the Central Massachusetts opioid crisis proves particularly fatal – but it is a business, and in this area of medicine, the playing field is not necessarily equal for patients or providers. This reality has shaped how addiction treatment companies have responded to the pent-up demand […]

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Downgrading DRGs: A New York Epidemic Out of Control

Do you find that your facility’s DRGs are being downgraded by third-party payers that are re-diagnosing patients? Are they also discounting the coding of suspected and possible diagnoses? You’re probably not alone. Sonya Manuel, a senior health information management (HIM) consultant and DRG coordinator for Jzanus Consulting in New York, tells RACmonitor that the battle […]

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CMS Posts New Medicaid IT Resources

The Centers for Medicare & Medicaid Services has launched an online resource to support states’ efforts to update outdated IT systems, Andy Slavitt, CMS’ acting administrator, announced on Monday.

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Four States Get ICD-10 Deadline Extension

Four state Medicaid programs have been approved by the Centers for Medicare & Medicaid Services to delay transitioning to ICD-10 codes by the Oct. 1 deadline.

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Medicaid ICD-10 Workarounds in Four States Worry Providers

On Oct. 1, Medicaid programs in four states will not be fully converting from the ICD-9 to the ICD-10 coding system,

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AMA’s Long War of Words Against ICD-10

One of the more notable things about the Centers for Medicare & Medicaid Services’ revisions to its ICD-10 policy on Monday is the fact that the suggestions come straight from the AMA. After all, there’s been no love lost between the two organizations when it comes to that subject these past few years.

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RAC Court Ruling Deals Blow to CMS

A US Court of Appeals ruling earlier this month that invalidates a provision of Medicare’s 2014 Recovery Audit Program contracts is the latest setback for federal officials who administer the program.

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SGR Replacement Bill Has Big Implications for Health IT

On Thursday, Senate and House lawmakers introduced bipartisan, bicameral legislation (HR 1470) to permanently replace Medicare’s sustainable growth rate formula that includes several health IT provisions, Modern Healthcare reports (Tahir, Modern Healthcare, 3/19).

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House Members Mull October ICD-10 Launch at Hearing

The U.S. implementation of the ICD-10 diagnosis coding system has been delayed several times, but members of a House subcommittee seemed to be leaning Wednesday toward making sure the current Oct. 1 deadline sticks.

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CMS to Feature ICD-10 Codes on its CMS-2728 End Stage Renal Disease Patient Registration Form

On July 31, 2014, the Centers for Medicare & Medicaid Services (CMS) formally announced that the U.S. Department of Health and Human Services (HHS) had finalized Oct. 1, 2015 as the new compliance date for healthcare providers, health plans, and healthcare clearinghouses to ICD-10.

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CMS Withdraws Medicare Secondary Payer Proposed Rule

A proposed rule that was expected to outline how Medicare’s interest should be protected in cases of settlements for future medical care was withdrawn Oct. 8 by the Office of Management and Budget.

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States Taking Initiative on Dual Eligible Cost Containment

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Why Must CMS Overreach on Rules?

Joseph Goedert Health Data Management Blogs, September 2, 2011 To prove meaningful use of electronic health records, providers must collect, organize and report data culled from certified electronic health records systems showing they that meet certain measures for quality of care. But they don’t send electronic data to the Centers for Medicare and Medicaid Services, […]

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Benefits of Medicaid EHR incentive program

Meaningful use expert Jim Tate has written that the Medicaid EHR incentive program reminds him of “zero entry” swimming pools: very easy to get into, with almost no barriers. Given its less stringent requirements compared to the Medicare EHR incentive program, Tate writes, he’s surprised that more eligible professionals are “not jumping into this incentive […]

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