Reuters: U.S. Tries Smarter Approach To Health Care Fraud Kaiser Daily Health Policy Report, December 17, 2010 The new approach is based on “predictive modeling,” a combination of advanced analytics, linkage analysis, behavioral analysis and other statistical techniques. Sebelius compared the modeling tools to ones often used by banks or insurance companies – that might, for example, throw up a red flag if there are unusual patterns of usage on a person’s credit card (Frasny, 12/16). ♦♦♦♦♥♦♦♦♦ Medicare Claim Review Programs: MUE, CCI, CERT, RAC” Booklet Revised… The Medicare Learning Network® has revised the “Medicare Claim Review Programs: MUE, CCI, CERT, RAC” booklet, which is designed to provide education on the different CMS claim-review programs and assist all providers in reducing payment errors – in particular, coverage and coding errors. It includes FAQs, resources, and an overview of the various programs, including Medical Review (MR), Recovery Audit Contractor (RAC), and the Comprehensive Error Rate Testing (CERT) Program. This product is suggested for all Medicare Fee-For-Service providers and is available in downloadable format. ♦♦♦♦♥♦♦♦♦ Medicare Bonus Payment Pilot Program Also A Test For ACO’s Kaiser Daily Health Policy Report, December 17, 2010 Modern Healthcare: Bonus Test Is A Test For ACOs Half of 10 physician groups testing Medicare bonus payments for quality and spending control earned payouts during the fourth year of the five-year experiment, the CMS has announced. Bonuses, which totaled $31.7 million for the fourth year, are based on how much physician groups save Medicare and how well doctors perform on measures of quality. Sound familiar? That’s because it’s the same basic formula behind accountable care organizations, a payment pilot for doctors and hospitals that Medicare will begin to implement in 2012 under the health reform law (Evans, 12/16). ♦♦♦♦♥♦♦♦♦ Adult Day, Senior Services & Hospice: Caregivers May Suffer From Compassion Fatigue Healthcare Industry Weekly Watch, December 20, 2010 Compassion fatigue is a syndrome seen in people who care for others with severe needs, such as hospice and elderly health professionals, social workers, police officers, and clergy, among many others, said Dr. Terry V. Eagan, practicing psychiatrist for 16 years and medical director of Moonview Sanctuary in Santa Monica, Calif. The syndrome may present itself in small, but powerful ways. The caregiver may feel depressed and irritable, resistant to offered services, negative about their work and less willing to work in teams, Eagan told Healthcare Senior Services Letter. It can be a pervasive sourness that “can spill over to other areas of life,” he said. Compassion fatigue is the “consequence of emotional burden,” such as caring for those who are sick, Eagan said. Read On… ♦♦♦♦♥♦♦♦♦ Report Medicare Fraud Report Fraud to Inspector General email: HHSTips@oig.hhs.gov Call: 1-800-HHS-TIPS (1-800-447-8477 TTY: 1-800-377-4950 ♦♦♦♦♥♦♦♦♦ |
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THOUGHT PROVOKING QUOTES “Resolve to perform what you ought; perform without fail what you resolve.” -Benjamin Franklin “When I thought I couldn’t go on, I forced myself to keep going. My success is based on persistence, not luck.” -Estee Lauder “Even when I lost, I learned what my weaknesses were and I went out the next day to turn those weaknesses into strengths.” -Larry Bird “All growth depends upon activity. There is no development physically or intellectually without effort, and effort means work.” -Calvin Coolidge “It’s the little things that make the big things possible. Only close attention to the fine details of any operation makes the operation first class.” -J. Willard Marriot ♦♦♦♦♥♦♦♦♦ |