“Finally Friday!” CERT-MLN on Medical Record Documentation & AMA/AHA RAC Suggestions

FRIDAY December 5, 2014:

AMA Suggests CMS RAC Overhaul

(to benefit Physicians, mostly, go figure)

PLUS

An Overview of CERT-MLN Education for

Complying With Medical Record Documentation Requirements

Watch the Replay and Get the Handouts

Not even the AMA seems to recognize the risk to physician payments. They only seem concerned with 14% of the appeals. Did they really read the report they quoted, and have they not heard of Transmittal 541? Click the image for the PDF.

The AMA sent a letter to CMS Administration, this week, offering several suggested modifications to the national RAC program.  Two of the five suggested changes are worth discussing, although they are not really surprising.

We went over the five suggestions made, paying particular attention to two of them: (1) the one about offering an optional appeals settlement offer for physicians, similar to the one recently offered to hospitals, and (2) the suggestion that physician audits should be performed by physicians of the same specialty, perhaps even one licensed in the same locality.

So – at a glance, be honest: what chances would you give those suggestions?

Also – did anyone else notice that the AMA seems oblivious to the risk that Transmittal 541 et al represents, and how that risk is exemplified by the other 720,416 denials appealed by hospitals, which they so nonchalantly show in their letter (see the table on page 3 of the letter)? (And I’m only mentioning the appeals reported by CMS, which is a bogus number.)

Okay, so maybe it’s just me.

AND – Hot off the Press from Medicare Learning Network & CERT…

Complying With Medical Record Documentation Requirements FACT SHEET

MLN partnered with CERT to produce this FACT SHEET – which might even be helpful. Click the image for the PDF.

We reviewed this new Fact Sheet in detail, which provides some useful references to MLN articles and even Medicare manuals which (we assume) will further explain these requirements.

Actually, Bill Malm went into quite a bit of detail about how some of this material is quite useful, and needs to be reviewed by hospitals.

In particular, he spent a fair bit of time reviewing the Vertebral Audmenation Procedures section, and the section on E&Ms.

 

Handouts for this Week's Show

AMA RAC Letter of December 3 2014
AHA OMHA Letter of December 4, 2014
AHA RAC Issue Brief 2014
AMA RAC Audits of E&M Services Fact Sheet
CERT-MLN Documentation Requirements Fact Sheet
MLN Oct 2014 Compliance Newsletter

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