Tag Archives: ernie de los santos

“Finally Friday!” Strategies for Medicare Level 3 Appeals

FRIDAY October 17, 2014 Medicare Appeals at Level 3: Providers Left in the Lurch Veteran Appeals Attorneys Review Recent Experiences with ALJs How Can You Prepare & Respond? Watch the Replay and Get the Handouts Since CMS began re-educating the … Continue reading

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“Finally Friday!” Solutions to RAC ADRs, Global Settlement Offer

FRIDAY September 26, 2014 Solutions to Recent CMS Initiatives How Some Providers Address Them Get the Handouts One thing’s for sure… it’s not boring around here, is it? This week we’ll cover two key subjects and the re-appearance of RAC … Continue reading

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“Finally Friday!” Final Word on Transmittal 541 and “Clawbacks”

FRIDAY September 19, 2014 The Final Word on “Clawbacks” Transmittal 505/534/540/541 Watch the Replay and Get the Handouts Project FAIL: when a government project fails, they just change it’s mission – reset the parameters, the expectations. That’s what happened with … Continue reading

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“Finally Friday!” Physician Documentation for a New Audience – Dr. John Zelem

FRIDAY September 12, 2014 “Are we documenting for a new audience?” Dr. John Zelem of EHR returned to advise us on what he’s been learning about this critical subject… Get the Handouts Our Guest was John Zelem, MD, FACS, General … Continue reading

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“Finally Friday!” CMS Global Settlement Offer for Existing Appeals of Inpatient Claims

CMS Offers 68% for Your Appeals: How will it work and is it a good deal ? Get the Handouts Late on Friday August 29, 2014, CMS issued proposed settlement terms to acute care hospitals with pending appeals of denials … Continue reading

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CMS Global Settlement Offer for Existing Appeals of Inpatient Claims

CMS Offers to Go “All In” for 68% CMS issued proposed settlement terms to acute care hospitals with pending appeals of denials for inpatient claims, on August 29, 2014. In an evident attempt to appease pressure from Congress and the provider … Continue reading

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“Finally Friday!” Key Changes in CMS FY2015 IPPS Final Rule

What Should You Know About the FY2015 IPPS Final Rule? Watch the Replay and Get the Handouts Surfers can choose to ride the wave or not. Providers have no such choice. Usually, there is much to dig into, when CMS … Continue reading

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“Finally Friday!” Can You Get Medicare to Pay for Surgery Prep?

Is Gray the New Black? Can You Get Medicare to Pay for Surgery Prep? Watch the Replay and Get the Handouts Since there was a lot of discussion this week on the rac-relief Google Group about how to handle cases … Continue reading

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“Finally Friday!” The Return of “Reach-Thru” or “Shadow” Denials – Transmittal 534

Transmittal 505 Resurrected as 534 or “Reach-Thru” Denials Are Back Get the Handouts This week, we looked at the newest wrinkle in what has been termed, “Reach-Thru Denials” and the latest version of a CMS rule that now will “…allow … Continue reading

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“Finally Friday!” Will CMS or Congress Kill Medicare’s 3-Day Qualifying Stay for SNF Coverage?

3-Day Stay for SNF Coverage: Will It Stand or Not? Regs Review & Another Quiz from Dr. Pahuja Plus: Interview with a Physician Advisor Double Certified as a Medical Auditor In a previous week, we heard from two practicing Physician … Continue reading

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