Perhaps everyone in our industry should read and be aware of the sentiment expressed in this recent 36-page Time Magazine article following the path of our healthcare dollars.  There are some pretty intense claims about the practices of hospitals – including nonprofits – that Capra Health’s clients should understand and be able to address in the public sphere.  This is as much cocktail party conversation as official press release, as we need to continue to resist many of the inaccuracies / misperceptions about our work. I’m very interested in what you think. Give us a call to chat about the article and for a complimentary set of talking points in response.

The article can be found here.



Long-Awaited HIPAA Privacy Regulations Released

January 25, 2013

On January 17, 2013, the U.S. Department of Health & Human Services (HHS), Office for Civil Rights (OCR), issued the final rule modifying the HIPAA Privacy, Security, Breach Notification and Enforcement Rules (Final Rule). Areas addressed include: Breach Notification Procedures Business Associates Definitions Marketing Rules Sales of Personal Health Information Research Regulations and Clarification Fundraising […]

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Latest edition of Medicare Quarterly Provider Compliance Newsletter released w/ insight into Contractor error findings posted

October 23, 2012

Please contact Capra Health for a complimentary consultation regarding any of the topics addressed in the newsletter: – Comprehensive Error Rate Testing (CERT) Finding: Power Wheelchairs – Recovery Audit Finding: Major Joint Replacement or Re-attachment with Major Complication or Comorbidity (MCC) – Recovery Audit Finding: Medical Necessity: Acute Inpatient Admission Respiratory Conditions – Recovery Audit Finding: Medical Necessity: Other Skin, Subcutaneous Tissue […]

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New RAC Pre-Payment Review for Region D (including Louisiana) Posted

October 16, 2012

HealthDataInsights, the recovery auditor (RAC) for Region D, will conduct a pre-payment review of medical necessity for MS-DRG 312 (syncope and collapse). This is the first RACs pre-payment review posted as part of the new pre-payment review system by CMS. The post states that: “DRG validation requires that diagnostic and procedural information and the discharge […]

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HHS-OIG Releases 2013 Workplan – Notice and Advice for Capra Health Clients

October 8, 2012

Last week, the HHS-OIG released its Work Plan for Fiscal Year 2013 (Work Plan), detailing the areas OIG will be scrutinizing in 2013. Below, please find a high-level summary of proposed investigations and examinations for 2013.  Capra Health clients should take this list seriously, as it often signals the areas that will experience reimbursement and […]

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Media Inquiries – Capra Health

October 1, 2012

Capra Health has significant experience providing media commentary on health policy and reimbursement matters. Media inquiries should be submitted to and will be responded to quickly, as we understand that television and print deadlines are inflexible. A past half-hour PBS interview with Capra Health President Blaine W. Lindsey, JD, MPH can be found below: […]

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Oklahoma Congressman Calls for Investigation of Federal Integrity Auditors

August 21, 2012

U.S. Representative Dan Boren (D-OK) has called for a federal investigation of CMS Recovery Audit Contractors (RACs) – organizations that audit hospital Medicare billing.  The Recovery Audit Program was established as an effort to reduce unnecessary and improper Medicare costs and have caused hospitals to implement expensive and time-consuming procedures to defend/prepare for those audits. […]

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Another layer of Medicare review coming for Louisiana hospitals

August 10, 2012

Louisiana hospitals will soon be subject to another layer of RAC review – this time in the form of a prepayment review for hospital admissions and other areas of concern.  Pilot program comes with 30 day submission period for all documentation and automatic denial at 45 days.  The administrative burden will be heavy for audited […]

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Official Launch of Capra Health

August 6, 2012

It is with great pride that I announce the launch of Capra Health!  Please let me know you thoughts on the website!  – Blaine Capra Health Launches Comprehensive Healthcare Reimbursement, Regulatory, and Compliance Consulting Services August 6, 2012 Capra Health ( announced today the launch of a new consulting firm dedicated to providing reimbursement, regulatory and […]

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Self Disclosure and the Importance of Monitoring Billing Contractors

July 2, 2012

Interesting case where a community hospital self-reported ambulance billing violations, and ended up with a $3.6M settlement with a begrudging statement of support from HHS. This case brings up a number of important issues for practice/hospital leadership to consider: 1) Very very large fine for a community hospital who self-disclosed. When our clients see numbers […]

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