Containing clinical costs in a safe manner in hospitals is crucial in the new value-based era of care. Reducing patient lengths of stay has been one of the main targets for clinical cost containment in hospitals. One-way hospitals can contain costs is by implementing...
The Medical Audit Common Reviews and their Risk The Healthcare Industry (both Payers and Providers) has always had a measure of audits and their “ripple effect” carries down the line whether it be workload i.e. record retrieval, desk auditing, refund request, data...
In my recent article “your audit losses begin in medical records” I discussed the role of the release of information officer in the dramatic impact that they can have upon audit losses. In this series we want to more deeply delve into how to consolidate your audit...
Your Audit Losses – Step One Of all the sites I’ve ever consulted for there is always the same pattern and posture with auditing. Some are better than others but all have divided the audit losses into generally three categories. 1. Business Office Denials 2....
Thanks to Report on Medicare Compliance for permission to reprint this article. Recently Christopher Baggott, CEO of Medlinks Cost Containment, Inc. and Medlinks Staffing LLC. was interviewed by the Report on Medicare Compliance on the issue of medical audits. Our...
Facing a storm can be daunting. As we close 2014 and welcome in 2015 CMS, the OIG, your commercial payers, all have their sites on your bottom line. CMS will surely revive rack RAC and the OIG predicts millions to be recovered in the audit of “canned documentation”....
In the last few years of servicing the needs of our clients a theme that comes through strongly is to un-silo departments and get them talking again. One of the big disconnects that we see is between the internal auditor in the contracting department. Our intention in...
Many of you are familiar with Aetna’s denial based on CMS rule 2202.6. Here”s a recent response Medlinks provided to one of our clients. ABC Hospital Health System bills according to CMS guidelines and rules with no delineation between payers, either government or...
Once in a Lifetime Procedures Summary This policy limits the frequency of reimbursement for certain identified procedures to once in the patient’s lifetime. Once in a Lifetime Procedures, by the nature of their description, can be performed only once in a patient’s...
Here in Reno, Nevada for the combined conference of Certification Council for Medical Auditors (CCMA) and the American Association of Medical Audit Specialists (AAMAS). I’m honored and pleased to announce that I’ve been elected President for the CCMA org. The CCMA,...
