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Many healthcare organizations avoid entering contingency-based arrangements with consulting firms that specialize in Medicare revenue optimization because they fear Federal investigation of such an arrangement might lead to a finding of fraud and abuse. A Medicare fraud alert issued by the HHS Office of the Inspector General (OIG) appears to justify that fear, suggesting that contingency arrangements are inherently unethical. Nonetheless, current Federal regulations clearly allow healthcare organizations to enter into contingency-based relationships with consulting firms to seek legitimate optimal payment. Healthcare organizations may do so without fear of Federal legal action if they ensure that the consultant is ethical and competent and that the DRG review process used is both legitimate and retrospective, subjecting all recommended changes to approval by both the healthcare organization and appropriate peer review organization.

Temperature-resolved molecular emission spectroscopy is described as a thermal analysis method for the analysis of solids and liquids. The technique uses an electrically heated graphite cup to decompose and/or vaporize the sample. The vapors are carried by a stream of argon into a cool hydrogen diffusion flame. Both the quantity and the nature of the decomposed species can be determined. The technique is particularly useful for the determination of sulfur, phosphorus, or nitrogen. Calibration curves for sulfur show the expected parabolic shape, and those for phosphorus are linear. The detection limit for elemental sulfur was determined to be approximately 50 ng. The evolution of sulfur is shown to be related to the decomposition temperature which is characteristic of the sulfur-containing species. Reproducibility of the decomposition temperatures is typically ±2%.

Tumors arising from or located within a peripheral nerve are not common and recognition and treatment are difficult. We report a patient with a myxoid swannoma surrounding the axon of ulnar nerve. This 50-year old woman had pain and tenderness. Careful clinical and technical investigation--including CT and angiography--could not give a definite diagnosis preoperatively. The patient was cured by simple enucleation without damage to the axon bundles. At surgery the appearance of the tumor was typical. An oval, encapsulated mass measuring up to 5.5 by 9 centimeters in diameter was seen. Only biopsy and pathologic examination can exclude malignancy. After follow-up of 48 months no local recurrence of the tumor was found.