OB-GYN Billing Mistakes That Trigger Audits — and Quietly Cost Practices $8K–$25K Per Quarter

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  The Part No One Warns You About Your OB-GYN claims are getting paid. Your revenue looks stable. Your billing team says things are “fine.” That doesn’t mean your practice is safe. Most OB-GYN audits don’t start with denials, warnings, or red flags you can see. They start silently , months after payers have already paid your claims—when the money has been spent, the charts are archived, and staff turnover has already happened. By the time the recoupment letter arrives, the damage is already done. The Reality Most Practices Learn Too Late Payers don’t audit claims they deny. They audit claims they’ve already paid . For OB-GYN practices, audits typically occur 6 to 18 months after payment . That timing is intentional. It gives payers leverage—because now you’re being asked to return money that’s already been allocated to payroll, rent, malpractice premiums, and growth. This isn’t a reflection of bad intent or sloppy practices. It’s how the system is designed. And OB-GYN...
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs

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The Trump Administration is taking aggressive actions and exercising regulatory flexibility to help healthcare providers contain the spread of the 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, the authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. CMS is ending the specific emergency declaration blanket waivers for SNFs/NFs, inpatient hospices, ICF/IIDs, and ESRD facilities. CMS passed several temporary emergency declaration blanket waivers for SNFs which were intended to provide healthcare providers with extra flexibilities required to respond to the COVID-19 pandemic.

Emergency Declaration Blanket Waivers for SNFs

3-Day Prior Hospitalization

Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of an SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only to those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).

Physical Environment

CMS is Waiving Requirements Related to 42 CFR 483.90, Specifically the following:

Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under § 483.90 to allow for a non-SNF building to be temporarily certified and available for use by an SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults. CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care. CMS will waive certain conditions of participation and certification requirements for opening an NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.

To know more about the COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs, click here: https://bit.ly/3zrYnCv Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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