The Centers for Medicare & Medicaid Services (CMS) operates within a budget neutral approach. This occurs at the same time the healthcare community continues to try and find balance between reducing administrative burdens, accurately recognizing and recording services provided, and upholding the highest quality care possible. Over the last three years, there have been significant […]
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FFY2020 Worksheet S-10 audits are in the final stages for most hospitals in the nation and we continue to see significant audit findings and extrapolation factors taking place throughout the industry. Please be sure to review all proposed S-10 audit adjustments closely to ensure your uncompensated care is maximized. Worksheet S-10: Two-Year Average of S-10 […]
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For years, Blue & Co. has received questions from hospitals regarding coding and billing for infusions, as well as documentation requirements. Infusion coding can be some of the most difficult coding for hospitals. It takes a certain understanding of 1) the required hierarchy, 2) what happens if a stop time is not recorded, 3) how […]
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In a post-pandemic environment, providers are more likely to refer patients for procedures, diagnostic testing, and physician visits to non-hospital environments. This presents an opportunity for healthcare leaders to re-exam their growth strategies and develop structure to define the market opportunity, redefine access as defined by providers and customers, and leverage data to prevent leakage […]
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A recent Blue & Co. audit of a small hospital’s existing Managed Care contracts yielded an unfortunate surprise: a nearly twenty-year-old contract with a major insurance company with rates that had not been updated since the original effective date. Not so surprisingly, these rates were woefully inadequate – reflecting a commercial rate that was only […]
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Recently there have been conversations around the potential new template from CMS that will be used for the Medicare Bad Debt listing that is filed with your organization’s cost report. As of July 2022, this new template is still in the proposed stage, and Medicare is accepting comments. You do not have to use this new […]
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Every hospital department deals with financial denials. Understanding the volumes of those denials for your outpatient therapy department can improve the net revenue of the department. A financial denial is when an insurance company or carrier refuses to pay for the healthcare services the individual receives. Within an outpatient therapy department, the level of denials […]
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In June, the Supreme Court gave hospitals participating in the 340B Drug Pricing Program a convincing victory ruling unanimously that the U.S. Center for Medicare & Medicaid Services (CMS) should not have reduced reimbursement for covered outpatient prescription drugs purchased by those hospitals. 340B Hospitals Challenge Payment Rates Hospitals challenged the 2018 and 2019 payment […]
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On July 7, 2022 the Center for Medicare and Medicaid Services (CMS) released the updated Nursing Home Five-Star Quality Rating Technical Users’ Guide with the methodology for the changes to the Staffing Rating and the Overall Quality Rating. Here is what your facility needs to know. Changes to the Staffing Rating CMS is basing the […]
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By: Tom Skoog, Cybersecurity & Data Management Practice Leader “Those who fail to learn from history are doomed to repeat it.” Sir Winston Churchill This is our fifth and final article in our five-part series on the importance of incident response planning as part of your cybersecurity program. As a reminder, the concept of Incident […]
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Carmel, Ind. (November 23, 2022) – The accounting and consulting firms of Alerding CPA Group (Indianapolis, Ind.) and Blue & Co., LLC (Carmel, Ind.) have announced their merger. The combined firm will operate as Blue & Co., LLC (Blue & Co.), effective December 1, 2022. This acquisition will provide Blue & Co. with greater market […]
By: Holly Fields, CPA, Senior Manager Not-for-profit organizations (NFPs) that receive federal financial assistance over certain levels, either directly from a federal agency or indirectly through state or local agencies, may be required to have a single audit performed under Federal Uniform Guidance. Single Audit Requirements A single audit includes not only an audit of […]
Every three years, the Centers for Medicare and Medicaid Services (CMS) requires any Hospital that is subject to the Inpatient Prospective Payment System (IPPS) to complete an Occupational Mix Survey (OMS). This data is then used to calculate an Occupational Mix Adjustment Factor (OMAF). The occupational mix adjustment impacts a hospital’s average hourly wage and […]
