Category Archives: Publications

Five Charged in $600 Million California Health Care Fraud Scheme By Dan Whitcomb | November 30, 2015 LOS ANGELES (Reuters) – The former chief financial officer of a California hospital and four other people have been charged in a series of health care kickback schemes that generated nearly $600 million in fraudulent billings for spinal surgeries, prosecutors said on Tuesday. All five defendants have… Continue Reading

Hospitals Form Patient Advisory Councils to Learn How They Can Improve Care By Laura Landro | November 29, 2015 After a hospital stay, patients may just want to put the experience behind them. The last thing they want to do is come back. Increasingly, though, they are doing just that—but at the request of the hospital, and in an effort to improve care. They are being… Continue Reading

Texas docs plead for relief from ‘meaningless abuse’ By Joseph Conn  | November 2, 2015 The Texas Medical Association wants Congress to intervene and make changes to the federal electronic health-record incentive payment program it’s calling “meaningless abuse.” The group says Stage 3 of the program meant to get physicians using EHRs could jeopardize Medicare doc payment rules. The TMA, the largest state… Continue Reading

HSMN Recognized

Health Systems Management Network, Inc. (HSMN) HSMN was founded in 1987 by two seasoned Clinical, Operational and Financial professionals. While our staff has grown, our focus has always been on the entire Revenue Cycle with special emphasis on Medical/Practice Staff on Clinical Documentation Improvement over every iteration of the various Coding Scenarios. Our “Start Ten… Continue Reading

Medicare Seeks to Expel Physicians from Its Program for Billing Medically Unnecessary Services

This Week Health Systems Management Network, Inc. is reporting that “Medicare seeks to fine and Expel Recalcitrant Providers”.  The reason they seek to do this is that, in their opinion, physicians are billing for “Medically Unnecessary” services.  According to CMS physicians do this despite knowing better. So a new program, “recalcitrant providers” has begun and… Continue Reading

What The OIG Wants Medicare to do to Find Fraud Among EHR Users

Health Systems Management Network, Inc. has been advising clients for 30 years through every iteration of coding and clinical documentation requirements including our most recent one (see our article on clinical documentation) advising our clients that “Cut and Paste” documentation is not only a compliance problem today but also for the transition from ICD-9 to… Continue Reading

Here’s Looking at You and You, and You, Kid

HSMN has had reports from several of its client hospitals asking us to come in and review cases that have been identified for audit.  These have not been RAC audits but reviews by third party payors who want to compare the hospital documentation and coding to the physicians who performed the service and or the… Continue Reading

What CEOs and CFOs Need to Know About the ICD-10 Transition

What is the difference between ICD-9-CM and ICD-10-CM? It’s a huge one, and it’s one that requires a marriage between critical thinking skills and the thinking that goes into medical decision making. In other words, the clinical staff will need hands-on efforts to master the new scenario which requires a level of specificity never required… Continue Reading

Revenue Cycle Management Under the ICD-10-CM Scenario

Health Systems Management Network, Inc.’s comprehensive implementation program for ICD-10-CM focuses on the entire revenue cycle. Wellington, FL — (SBWIRE)  — Health Systems Management Network, Inc.’s comprehensive implementation program for ICD-10-CM focuses on the entire revenue cycle. Their view is that the revenue cycle begins with the first contact with the patient and the collection… Continue Reading