RMC’s Blog
OIG: Medicaid Fraud Control Units 2020 Report
Medicaid provides coverage and healthcare services with federal and state funding to 72.2 million people in the Unites States. This coverage is for those with limited income and resources i.e., low-income adults, children, pregnant women, elderly adults, and people...
Medicare and Medicaid Recovery Audit Contractors . . . Continue Their Efforts
Protecting the Medicare Trust Fund is an important priority for the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General and thus we have Recovery Audit Contractors or “RACs”. Through the...
CPT Releases New COVID-19 Vaccine Code
We all are aware of the currently available COVID-19 vaccines from AstraZeneca, Janssen (Johnson & Johnson), Moderna and Pfizer and their unique CPT® codes. These medical codes allow for each vaccine and immunization administration to be clinically distinct,...
OIG Specific Medicare Audit Report: Compliance with Inpatient and Outpatient Claims
Another Office of Inspector General (OIG) Medicare audit report was released in early May 2021 titled, “Medicare Hospital Provider Compliance Audit: Virtua Our Lady of Lourdes Hospital”, this hospital is located in New Jersey. These ongoing OIG Medicare audit...
The FY2022 Proposed Inpatient Prospective Payment System (IPPS) Rule Is Released
With the last 14 months being impacted by the COVID-19 public health emergency (PHE), we experienced significant changes and revisions to policies across the continuum of healthcare. It’s time once again for the Inpatient Prospective Payment System (IPPS) proposed...
SDOH . . . Value and Importance Continues to Grow
Over the past year we have seen and read more and more about the reporting of Social Determinants of Health or “SDOH". Clearly there has been a COVID-19 impact to the overall interest in these social economic and psychosocial aspects of an individual. More research...
OIG Reports on Humana MA HCC Dx
The Office of Inspector General (OIG) released a recent report (4/2021) titled “Medicare Advantage Compliance Audit of Diagnosis Codes that Humana, Inc., (Contract H1036) Submitted to CMS”, which should wave a flag for compliance and Health Information Management...
ICD-11 . . . What Does the NCVHS Full Committee Analysis Tell Us?
Have you noticed that we are reading and hearing more and more about ICD-11? Looking back over the past few years we see that in June 2018 the World Health Organization (WHO) published (released) ICD-11 for review and the World Health Assembly formally adopted this...
CPT Coding Injections and Infusions . . . Continues to be Challenging
Current Procedure Terminology or CPT® is the registered trademark of the American Medical Association (AMA). The codes in CPT are 5-characters in length, with over 10,300 Category I, II and III codes, Category I covers the Evaluation and Management visits, Anesthesia,...
Post-COVID-19 Signs and Symptoms – Sequelae Continues
The daily news surrounding COVID-19 includes information and facts from those individuals who were diagnosed with COVID-19 but they now are in the recovery stage and have “Post-COVID-19” signs and symptoms. A recent study in Nature Medicine (March 22, 2021),...