There was a time when therapy documentation was the focus of Recovery Audit Contractor (RAC) audits.
Under the Patient-Driven Payment Model (PDPM), however, reimbursement for Medicare Part A patients being treated in skilled nursing facilities (SNFs) will be driven by patient condition, rather than therapy minutes. And this creates a target-rich opportunity for auditors, because certain documentation can easily lead to higher reimbursement – and the likelihood of audits leading to claim denials.
Reporting on this development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.
Other segments to appear during broadcast include:
- Court Report: The Reckitt Benckiser Group has agreed to pay $1.4 billion to resolve its potential criminal and civil liability related to a federal investigation of the marketing of the opioid addiction treatment drug Suboxone. Whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on how an addiction specialist filed a False Claims Act (FCA) motion leading to the largest settlement in U.S. history related to the opioid crisis.
- Monday Focus: Senior healthcare analyst Frank Cohen returns to Monitor Mondays with a unique perspective on artificial intelligence (AI). Cohen reports on how the more accurate term for the ubiquitous AI should be “augmented intelligence,” as it relates to non-clinical areas of healthcare.
- SDoH Report: Ellen Fink-Samnick, nationally recognized expert on the social determinants of health (SdoH), will have the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.
- Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.
- Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.