The rules of medical necessity and medical decision-making (MDM) are sure to trump the complexity of tax law for the foreseeable future. As the government continues to pump auditing contractors with funds to "fish," the standard algorithm to determine medical necessity has become highly proprietary as providers find themselves under investigation for issues tied to inpatient and outpatient evaluation and management services. As the first of two pieces on this matter, this article will explore the processes of calculating medical necessity, and medical decision-making - and the subjective regulations that factor in.

Gill Compliance is excited to announce the newest member of the team, Nicole Benson.

Gill Compliance Solutions is growing and has brought on an extraordinary new leader to the company, Tresa Brown!  

Physicians are receiving letters citing "Section 1842 (a)(1)(c) of the SSA requiring carriers under contract to the Centers for Medicare & Medicaid Services (CMS) to conduct audits to ensure that Medicare claims are being paid correctly."

As the Centers for Medicare & Medicaid Services (CMS)  announced its record-breaking recovery effort of $4.1 billion for 2011, providers and hospitals were bracing for new depths of audits by government contractors.

The Boise GCS staff takes pride in giving back to local communities.  Jana and Lisa spent time volunteering for the Habitat for Humanity organization painting the interior of a home.  It was so much fun and gratifying knowing your hard work goes to helping others in need.

Marilyn Tavenner, the Centers for Medicare and Medicaid Services (CMS) Administrator, announced that CMS will re-examine the timeframe of the ICD-10 deadline through a rulemaking process with more details to follow in the coming days. 

James Madara, executive vice president and CEO of the American Medical Association (AMA) reached out to John Boehner, the House Speaker (R-Ohio), asking him to stop the federally mandated implementation of the ICD-10 coding system. 

Gill Compliance Solutions has brought on two exceptional leaders to the company! Marilyn Glidden our Claims & Auditing Specialist, and Stephanie Krautkramer our Senior Auditor, each bring an array of experience to the GCS team.

Jana talks about how the OIG has opened up new opportunities for the RAC through its 2012 Work Plan.