From Report on Medicare Compliance - Patients in the gray area of medical necessity present a regulatory, reimbursement and ethical challenge for hospitals. If patients need only custodial care, which is not covered by Medicare, hospitals are playing with fire if they submit claims for anything except ancillary services. But sometimes what seems to be a social admission is really medically necessary and it just hasn’t been documented well. Or hospitals may have other reimbursement options, including the use of an advance beneficiary notice (ABN) and the hospital-issued notice of non-coverage. Read more
From Report on Medicare Compliance - With recovery audit contractors (RACs) on light duty and Medicare administrative contractors (MACs) limited to probe-and-audit reviews under the two-midnight rule, Colleen Dailey, clinical coordinator of defense audits at WellSpan Health, is knee deep in claim denials from commercial payers. It’s a different world than Medicare, because the denials often stem from problems with preauthorizations for diagnostic tests, which are sometimes a matter of chasing down paperwork under the gun… Read more
From Report on Patient Privacy - You can’t miss the headlines: “Coming in 2015: Even more health care data breaches,” “Health care to be ‘plagued’ by data breaches in 2015.” Several organizations have released reports pinpointing the threat health care faces from hackers and malware and predicting growth in breaches this year. Experian Data Breach Resolution, a well-respected company that has helped businesses plan for and mitigate consumer risk following data breach incidents for more than 10 years,… Read more
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