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Changes afoot for chargemaster

Ever since "Bitter Pill," Steven Brill's mammoth 24,000-word cover story in TIME magazine this March put the spotlight on this shadowy reference tool - a voluminous file that dictates the cost of the services and medicines and hardware a hospital provides - the public has become aware in a way it hadn't been before that the prices paid by healthcare consumers often have very little logic to them.

RAC Latest News

RAC Enews

RACmonitor.com is an online news and information source to help healthcare providers make informed decisions for their organizations on the activities of Recovery Audit Contractors — the congressionally mandated program under the auspices of the Department of Health and Human Services (HHS) and administered by the Centers for Medicare and Medicaid Services (CMS). RACmonitor.com is not affiliated with any governmental agency but is a source for healthcare providers in all settings.
  • RAC Region B contractor CGI posted a semi-automated review on March 26, 2014, for Outpatient provider types regarding the medical necessity for the drug Cetuximab. Per the contractor’s description of this issue, a semi-automated edit to identify potential incorrect billing occurring for Cetuximab claims billed with an ICD-9-CM code that...

  • The False Claims Act (FCA) is far from a new or modern construct honed against the purportedly promiscuous field of healthcare. The FCA since the late 1990s has become synonymous with the healthcare industry, a development arguably prompted by dramatic changes to the act in 1986, but that was not...

  • If you are running a hospice and are not under audit by one of the many governmental bodies out there, you are either very lucky or you are fibbing. The pattern has expanded to include Medicaid through a variety of subcontractors here in Florida. Many of the hospices across the country...

ICD10 Latest News

ICD10 eNews

ICD10monitor, a division of Panacea Healthcare Solutions, Inc., is an online news and information source created to help healthcare providers make informed decisions as they transition to ICD-10, a process mandated by Congress under the auspices of the U.S. Department of Health and Human Services (HHS) and administered by the Centers for Medicare & Medicaid Services (CMS). ICD10monitor .com is not affiliated with any governmental agency but is a reliable source for healthcare providers in all settings. ICD10monitor provides a portal of information and a forum for discussion for educational purposes only. The opinions of contributing editors published by ICD10monitor may not necessarily represent those of our sponsors or other organizations affiliated with ICD10monitor. While every effort is made to ensure accuracy and contextual honesty. ICD10monitor will quickly correct and/or retract any information demonstrated to be erroneous. We welcome opposing viewpoints and will publish responses from our readers, which may be edited for economy and clarity.
  • Dennis Winkler Sib Herbert The questions came flying in from audience members during a recent broadcast of Talk Ten Tuesdays in which two payer representatives — Dennis Winkler from BlueCross-BlueShield of Michigan and Sidney Hebert with Humana —were interviewed. In light of the many questions that were submitted during the live broadcast, here is a sampling of those sent to Talk Ten Tuesdays, along with written comments by both Winkler and Hebert. Sid and Dennis — can they speak to the possibility of dual use (coding in I-9 and I-10) come Oct. 1st 2014? Will they allow live production submissions...

  • February 2014 brought the Winter Olympics to Sochi, Russia. More recently, it seems to be the beginning of the ICD-10 Implementation Olympics in the United States. There are only 541 days (as of April 8) left before the opening ceremonies, with the passage of HR4302! As we rewind our ICD-10 implementation activities, please consider these events in your project plans. There are several events in the ICD-10 Olympics, including financial investigations, testing, education, software remediation, business operation transition, and communication. Qualifying runs for these events should be in full swing. Let’s look at each: Financial Investigation: Organizations should be reviewing...

  • There are 17,045 codes in ICD-10-CM that relate to fractures. And 10,582 fracture codes are used simply to distinguish right versus left. In preparation for ICD-10, physician documentation must be assessed and gaps identified to ensure correct coding of your orthopedic encounters. There are five fundamental criteria for ramping up fracture documentation: Specific site of the fracture Laterality General characteristics of fracture type Other specific characteristics Seventh-digit extensions According to the Coding Clinic published during the first quarter of 2013, coders can use X-ray reports to assign a code for specific site of the fracture once the provider has already...

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