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October 5

American Hospital Association Calls on CMS to Address ‘flaws and inaccuracies’ in OIG Audits

In a letter dated October 2nd, the American Hospital Association has called on CMS to take a more active role regarding hospital compliance reviews conducted by the Office of Inspector General (OIG).  Citing fundamental flaws and inaccuracies, both in the OIG’s understanding and application of Medicare payment rules and in the procedures used to conduct […] Read More

August 28

CMS To Expand Targeted Probe and Education Program

Citing a decrease in appealed claim decisions and an increase in the acceptance of provider education under the pilot program, CMS has announced that they have decided to expand the Targeted Probe and Educate (TPE) program to all MAC jurisdictions in latter part of 2017.  The TPE program grew out of the broad Probe and […] Read More

August 15

Appeals Court Overturns Ruling Requiring HHS to Clear Medicare Appeals Backlog By 2021

On Friday, the U.S. Appeals Court for the District of Columbia overturned an order requiring Department of Health and Human Services (HHS) to clear its backlog of Medicare reimbursement appeals by the end of 2020. Indicating that the district court “declined to seriously grapple with the Secretary’s assertion that lawful compliance with such a mandamus […] Read More

July 25

CMS proposes removing total knee replacements from inpatient-only list

In the 2018 OPPS proposed rule, CMS is moving ahead with a proposal to remove total knee replacements under CPT code 27477 (arthroplasty, knee, condyle and plateau; medial and lateral components with or without patella resurfacing (total knee arthroplasty)) from the inpatient-only list. If finalized, the procedure would be added to comprehensive APC (C-APC) 5115 […] Read More

March 10

HHS indicates it cannot eliminate Medicare appeals backlog by the end of 2020

In a status report filed with the U.S. District Court for the District of Columbia HHS indicated that “although the initiatives undertaken by HHS have significantly slowed the growth of the backlog, the significant annual reductions that this court has directed are not possible given current funding and legislative authorities.” The court directive, issued on […] Read More

December 18

District Court Orders HHS to Eliminate Medicare Appeals Backlog

On Monday, in an opinion issued by Judge James Boasberg, the U.S. District Court for the District of Columbia ordered the Department of Health and Human Services (HHS) to clear its backlog of Medicare reimbursement appeals by the end of 2020. Judge Boasberg’s opinion granted a motion for summary judgment filed by the American Hospital […] Read More

November 3

CMS Posts 2016 Hospital Appeals Settlement Details

Today, the Centers for Medicare and Medicaid Services (CMS) posted the highly-anticipated details of the 2016 Hospital Appeals Settlement. Beginning December 1, 2016, CMS will make available an administrative settlement process for inpatient status claims. This process will be open to eligible hospitals willing to withdraw certain pending appeals in exchange for timely partial payment […] Read More

November 1

CMS Awards New RAC Contracts

On Monday, October 31st, the Centers for Medicare & Medicaid Services (CMS) announced that they had awarded the long-awaited new round of contracts for the Medicare Fee-for-Service Recovery Audit Contractors (RACs). The agency identified the awarding of contracts to the following: Region 1 – Performant Recovery, Inc. Region 2 – Cotiviti, LLC Region 3 – […] Read More

October 3

CMS Reopens Medicare Appeals Settlements

CMS has announced that they will reopen the Appeals Settlement to allow eligible providers to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process. Specific details of the settlement have not yet been released. W&W will be monitoring CMS announcements for release of the settlement details. Read More

September 15

BFCC-QIOs to Resume Two-Midnight Reviews

CMS has announced that, effective September 12, 2016, BFCC-QIOs will resume initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities to determine the appropriateness of Part A payment for short stay hospital claims.  Per the CMS announcement, the temporary suspension, which was instituted on May […] Read More

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