Archive for September 2017
CMS Issues Guidance on When a Hospital is a Hospital
Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now…
Read MoreJoint Commission Issues Alert on Hand-off Communication
“What we have here is a failure to communicate” is a line from the 1967 film Cool Hand Luke. It’s also a problem in the world of healthcare when one provider hands over a patient’s care to another for continued care and treatment. Earlier this month, the Joint Commission issued a new Sentinel Event Alert…
Read MoreThe FCA and the Use of Statistical Sampling
The U.S. Department of Justice late last month agreed to a $275,000 settlement in a False Claims Act case against a South Carolina-based company that operates elder care facilities. What’s significant about this case is that two years earlier, the DOJ rejected a significantly higher – $2.5 million – settlement. In the initial case, United…
Read MoreNew vs. Established Patient Billing: Are You Doing It Properly?
It’s no secret that the Department of Health and Human Services Office of the Inspector General (HHS OIG) has been scrutinizing how Medicare pays providers for new and established patients. Such scrutiny has resulted in providers having to pay back millions for incorrectly billing for a new patient visit when the visit should have been…
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