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- Strike Force arrests 53 individuals in Medicare fraud scheme
On June 24, the Medicare Fraud Strike Force in Detroit arrested 53 people on Medicare fraud charges, halting the defendants’ schemes to submit more than $50 million false Medicare claims, according to an HHS press release.
- Note: Inpatient Part B benefit - limited services payable under Part B to hospital inpatients
Although there were several transmittals and other CMS issuances published during the past week, they were primarily technical in nature rather than of general interest. Having just completed an MBC-H course in Chicago, I was reminded of a topic that I have wanted to discuss for some time. Although not new--that is, there have been no recent changes—there are several things that participants seem surprised about when we discuss them in class. Under the limited inpatient Part B benefit, hospitals can bill Medicare for certain nonphysician services furnished by a hospital (directly or under arrangements) to an inpatient of the hospital when these services are not covered under Part A.
- CMS releases RAC audit phase-in strategy: Complex reviews to arrive as soon as August
CMS released further information June 24 on its RAC Web site letting healthcare providers know when they can expect RACs to begin auditing. The new “CMS RAC Review Phase-in Strategy,” details different types of reviews and dates CMS anticipates the reviews will begin in various areas of the country.
- CMS warns industry about fax scam
On June 18, many providers received an alert message from CMS informing them that scammers are sending fake faxes and posing as a Medicare carrier or Medicare Administrative Contractor (MAC) in order to obtain billing information.
- Note: More on condition code 44 and observation
This is an especially light week of publications from CMS, so I thought I would update you a bit on an issue that we have included in recent postings, which has resulted in a number of questions from readers. In two recent articles related to use of condition code 44, we indicated that, based on the written manuals, it appeared inappropriate to report the hours from the beginning of the stay as observation when converting the stay to outpatient.
- Meaningful Use First Draft Could Guide Final Definition
The Health Information Technology Policy Committee stressed on Tuesday that the meaningful use definitions recommended by a study committee this week are merely a non-binding "first step" in a complex winnowing process.
Spotlight
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Medicare Boot Camp - Hospital Version
Medicare Boot Camp - Hospital Version, is a five day intensive course on Medicare coverage, billing, coding and payment for hospital outpatient and inpatient services. It gives you the knowledge and tools to find the answers to your most pressing Medicare issues. Click here to download a pdf of the current brochure.Hospitals are under increasing financial pressure and Medicare can account for a large portion of their revenue. With RACs set to roll out in 2010, hospitals will be scrutinized more closely than ever before. Get it right for revenue integrity on the front end. Understand and apply the rules to protect that revenue from audits and recoupments on the back end.For more information, including how to register for Medicare Boot Camp - Hospital Version, visit the HCPro Boot Camps Web site.