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OIG reports Medicare nursing home upcoding

Skilled nursing facilities in many instances may be billing for higher-paying therapies that aren’t always necessary, according to a report from the Dept. of Health and Human Services Office of Inspector General. OIG determined that these facilities improperly billed a quarter of all claims in 2009, resulting in $1.5 billion in inappropriate payments out of the nearly $27 billion paid to them that year. Medicare typically pays higher rates for therapies than it does for non-therapy services. OIG determined that most of the facilities’ incorrect claims were due to up-coding, or billing for therapies in higher payment categories that weren’t necessarily warranted. Another small percentage of these claims failed to meet Medicare coverage requirements, the report stated. In many cases, facilities didn’t report the correct amount of therapy a patient either received or needed, or they misreported information on whether patients were receiving special care or on the amount of h ...

Reminders linked to sizable increase in cancer screening rates

Interventions aimed at guiding patients and helping them better understand colorectal cancer screening can significantly boost screening rates, says a study published online Nov. 1 in Cancer Epidemiology Biomarkers and Prevention. Researchers examined two types of interventions, including mailed materials and phone calls, and found that patients who received those services were about three times as likely to undergo screening than those who had neither. Colorectal cancer is the third-leading cause of cancer-related deaths in the U.S. There will be an estimated 103,170 new cases of the disease and 51,690 related deaths in 2012, according to the American Cancer Society. For the study, 945 patients ages 50 to 79 participated in the randomized, controlled trial. Of those, 312 received a tailored navigation intervention in which they were asked whether they would prefer undergoing a colonoscopy or taking a stool blood test. Based on their preference, those patients were mailed eith ...

Work-hour limits reduce resident fatigue — and confidence

Restrictions on the number of hours in a week that resident physicians can work have helped decrease fatigue among young physicians but may make them less prepared to practice medicine, according to an Annals of Surgery study published online Oct. 12. Researchers surveyed 216 orthopedic residents before and after the implementation of work-hour rules by the Accreditation Council for Graduate Medical Education in 2003. Residents reported feeling less fatigued as a result of the changes, although the amount of sleep they received did not change significantly. Residents surveyed slept an average of 34.6 hours per week in 2003, compared with 33.7 from 2004 to 2009, the study said. “This really challenges one of the primary assumptions about duty-hour standards — that if you let obviously-tired residents go home earlier more often, that they would sleep more. But they’re not sleeping more,” said Debra Weinstein, MD, senior study author and vice president for graduate medical e ...