Tag Archives: ron hirsch

“Finally Friday!” Short-Stay DRGs & Pay-to-Appeal

FRIDAY May 1, 2015: Short-Stay DRGs & Pay-to-Appeal: What to expect and when Get the Handouts Day Egusquiza, a passionate and in-demand speaker and educator, told me last week that she thought the plans for a Short-Stay DRG were not … 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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The Return of “Reach-Thru Denials” – CMS Transmittal 534

“Reach-Thru” or “Shadow” Denials You Can’t See Them Coming CMS Transmittal 505, issued February 5, 2014 and effective March 6, 2014, modified Section 3.2.3 of the Medicare Program Integrity Manual, to authorize all their various contractors who process and review … Continue reading

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“Finally Friday!” Decision Trees for 2-Midnight Rule Conversions

Joining us this week was a panel of experts discussing our handouts, decision trees for: Day One Day Two Day Three & Beyond Conversion of OP to IP Find the PDFs below – download and post, copy, distribute, whatever – … Continue reading

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“Finally Friday!” MAC Probes, AHA Lawsuits, and OIG Reports on E/M

Bill Malm of Craneware reviews some new OIG Reports, foreshadowing perhaps a flood of E/M Audits by CMS contractors. We also hear from Dr. Ron Hirsch of Accretive PAS about some of the insanity coming out of the MACs in Probe and Educate. Jessica Gustafson and Abby Pendleton from The Health Law Partners give us some legal perspective on the OIG postings, and a short review of the recent AHA filing of a mandamus complaint – a filing seeking a judicial remedy to require CMS to “meet statutory deadlines for administrative review of denials” for Medicare claims. Continue reading

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