by RMC Inc. | Aug 6, 2021
For twenty-four (24) years now the Department of Justice (DOJ) has been in combat against healthcare fraud and abuse through the “Healthcare Fraud and Abuse Control Program” or HCFAC. We can be thankful for HIPAA (Health Insurance Portability Accountable Act) which...
by RMC Inc. | Jun 30, 2021
According to a recent Centers for Medicare and Medicaid Services (CMS) MLN Connections, Medicare Administrative Contractors (MAC) are beginning to conduct post-payment medical reviews for dates of services (DOS) after March 2020. After a pause in audits due to...
by RMC Inc. | May 21, 2021
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...
by RMC Inc. | Mar 30, 2021
The words “Hierarchical Condition Categories” or HCCs can conquer up some anxiety for HIM Coding, and Clinical Documentation Integrity (CDI) professionals, even for Revenue Cycle and Compliance leadership. Add to that, the word “audit” and we now have uneasiness and...
by RMC Inc. | Mar 10, 2021
The Office of Inspector General (OIG) released a report on the concerns surrounding inpatient hospital stays with high levels of severity between 2014-2019. There was a reported 20 % increase found in the DRG (Diagnostic Related Group) severity levels, which are...
by RMC Inc. | Jan 29, 2021
A new OIG (Office of Inspector General) report has been released that is important to review. The title is: CMS and Its Contractors Did Not Use Comprehensive Error Rate Testing (CERT) Program Data To Identify and Focus on Error-Prone...
