Community Hospital in Munster, Indiana, is disputing an Office of Inspector General (OIG) report that found DRG assignment errors and incorrect inpatient rehabilitation facility (IRF) claims, resulting in an projected $22,051,602 in overpayments.Read More »
CMS is seeking comments on a proposed coverage with evidence development for chimeric antigen receptor T-cell (CAR-T) therapy for relapsed or refractory cancer when prescribed by the treating oncologist.Read More »
The improper payment rate for routine venipuncture lab tests was 16.3% in 2018, representing more than $20 million, and medical necessity errors accounted 98.9% of the improper payments, according to CMS.Read More »
It’s hard to believe planning for the 2019 Revenue Integrity Symposium (RIS) is already underway. It feels like just yesterday we were all gathered in Phoenix exchanging ideas, learning about the latest regulatory changes, and soaking up that desert sun at 2018 RIS. The symposium is NAHRI’s...Read More »
Q: We have patients that come to the emergency department (ED), are seen by a physician assistant, nurse practitioner, doctor of osteopathic medicine, or medical doctor, have tests ordered, then leave before the tests results are given to the patient. Can the facility charge an ED visit or not...Read More »
CMS released additional instructions to the Medicare Claims Processing Manual for the accurate interpretation of claim edits and assignment of modifiers -59 and -91 on Medicare Part B claims.Read More »
