Medical Necessity

Pay for performance, medical necessity and Jimmo

Pay for performance, medical necessity and Jimmo

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Why would anyone mention value-based reimbursement, medical necessity and the Jimmo lawsuit in the same sentence? I feel they are all related, but it will be difficult to find the perfect balancing act to maximize the benefits of each topic.

Ask the payment expert ... about RAC nursing home audits

Ask the payment expert ... about RAC nursing home audits

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We keep hearing about RACs in skilled nursing homes but we haven't seen any in our state, so why should we worry about them?

Ask the payment expert ... about monitoring therapy services

Ask the payment expert ... about monitoring therapy services

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Q: What should an administrator do to monitor therapy services in his or her facility? A: The main fact to remember is that you are responsible for what happens in your therapy department, even if you have a contract company.

Make CMS audits less burdensome, providers urge lawmakers

Make CMS audits less burdensome, providers urge lawmakers

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The Centers for Medicare & Medicaid Services could take a variety of steps to make audits less burdensome, healthcare providers stated in white papers submitted to members of the Senate Finance Committee. The committee released a report Thursday, summarizing stakeholders' input and recommendations for improving the audit process.

Medical necessity — slippery for some

Medical necessity — slippery for some

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Medical necessity has become a common phrase in healthcare terminology, but what exactly does it mean? Unfortunately, this term has become very subjective and is the primary reason we have been denied payment for services.

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