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CMS Implements Uniform Provider-Based Checklist

CMS recently instructed its Medicare Administrative Contractors (MACs) to use CMS's electronic provider-based (PB) checklist. In a One-Time Notification, CMS advised that it had been receiving different PB checklists from its...more

D.C. District Court Strikes Down PRRB's Application of "Self-Disallowance" Jurisdictional

In Banner Heart Hospital, et al. v. Burwell, the United States District Court for the District of Columbia (Court) held on August 19, 2016, that the Provider Reimbursement Review Board (PRRB) incorrectly declined to hear an...more

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more

CMS Limits MAC and QIC Scope of Review

Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) should not expand redeterminations and reconsiderations of claims denied on the basis of complex pre–or post–pay payments or automated...more

CMS Proposes Limited Exception to Two-Midnight Rule and QIO Review of Short Stays

In the 2016 inpatient prospective payment system (IPPS) proposed rule, CMS promised to provide further guidance on the controversial "two midnight" rule in the forthcoming outpatient prospective payment system (OPPS) rule....more

CMS Issues DSH Ruling 1498-R2

CMS recently issued Ruling 1498-R2 (Ruling), dated April 22, 2015, amending its 2010 Ruling 1498-R. The new Ruling addresses the calculation of the Medicare fraction of the disproportionate share hospital (DSH) adjustment for...more

CMS Announces Provider Relations Coordinator for RAC and MAC Issues

CMS recently announced that it has established a CMS Provider Relations Coordinator, Latesha Walker, to assist providers in resolution of issues with Recovery Auditor Contractors (RACs) and Medicare Administrative Contractors...more

CMS Posts Guidance on Two-Midnight Rule and Related Audits

On February 24, 2014, CMS posted a list of updates to its guidance on the new Two-Midnight Rule and the Probe and Educate Audits. Several of the more major updates are discussed below....more

3/12/2014  /  Audits , CMS , Healthcare , MACs , Medicaid , Medicare

CMS Extends Time for Probe Audits of Inpatient Admissions, and Clarifies Inpatient Order and Certification Requirements

Probe and Educate Audits of Inpatient Admissions Extended - CMS announced on its Inpatient Hospital Review website on Friday that it was extending the probe and education audits of inpatient admissions for an...more

CMS Releases Guidance for MACs on 100% Prepayment and Random Medical Reviews

On October 18th, CMS issued Transmittal 489 [PDF], providing Medicare Administrative Contractors (MACs) with instructions on 100 percent prepayment and random reviews. The guidance, effective November 19, 2013, provides MACs...more

11/14/2013  /  CMS , Compliance , Healthcare , MACs , Medicare

CMS Issues Additional Guidance Related to 2-Midnight Rule

Earlier this month, CMS posted three new documents related to the 2-midnight rule for inpatient admissions on its webpage for inpatient hospital reviews: new FAQs, as well as CMS directions for selecting hospital claims for...more

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