This week we were joined by Paula Digby, CEO, Auditor and Trainer at AQ-IQ.com. Paula holds certifications for CCS, CDIP, CPC, CPCI, and is an AHIMA Approved ICD-10-CM/PCS Trainer. Paula went over the biggest sources of lost money in your Emergency … Continue reading
The most interesting exchange is at 44:00 in…
“Scope Creep” in Appeals is Dead CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied. For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, Limiting the scope of review on redeterminations and reconsiderations of certain claims. MLN Matters Number SE1521.
CMS should focus its billing audits less on verifying medical necessity and more on rooting out blatant fraud, the agency’s likely next secretary said Tuesday. Rep. Tom Price, R-Ga.
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