A Perfect Storm: Agencies Collaborate on Medical Debt, Price Transparency, Charity Care
Kathryn Beard, JDAugust 17, 2023
Almost 40% of Americans recently reported they were deferring medical care due to the cost of treatment.1 This is particularly true for Americans with low incomes, who have reported cancelling treatment for even the most serious conditions due to an inability to pay for necessary services.
Financial ...
Why Prior Authorization Reform Should Garner Provider Support
R1 Regulatory TeamApril 14, 2023
In the United States, prior authorization (“PA”) is a cost-containment tool utilized by payers to reduce payment for medically unnecessary or inappropriate patient care. Despite its laudable policy goals, the use of PA faces
The Future of Good Faith Estimates Under the No Surprises Act
R1 Regulatory TeamJanuary 18, 2023
The No Surprises Act of the 2021 Consolidated Appropriations Act (“NSA”) established requirements for healthcare providers to deliver Good Faith Estimates (“GFEs”) for scheduled services or upon patient request.
Key Takeaways:
- Indefinite extension of co-provider and co-facility enforcement ...
Hospital Price Transparency: Lessons Learned, Best Practices
R1 Regulatory TeamDecember 19, 2022
Federal price transparency requirements for hospitals from the Centers for Medicare & Medicaid Services (CMS) provide patients with an unprecedented amount of insight into the costs for medical services.1
In theory, more pricing information should ...
RACMonitor: Why Too Much News is a Good Thing
Dr. Ronald HirschOctober 18, 2022
It is time for another multi-topic update. Some weeks produce just too much news to limit my reporting to one topic.
RACMonitor: AMA Misses Opportunity to Simplify Hospital E&M Coding
Dr. Ronald HirschSeptember 25, 2022
AMA scores a hit with new guidelines; misses simplification of one subset of hospital E&M codes.
RACMonitor: Medicare Advantage -- No Apparent Advantage for Some
Dr. Ronald HirschSeptember 16, 2022
Complaints are abundant from beneficiaries.
RACMonitor: Patient Truly Ill? Why Random Audits Could Prevent Recoupment
Dr. Ronald HirschSeptember 9, 2022
Recently, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released an interesting audit. They audited billing of critical care visits by physicians who are employed by Lahey Clinic in Massachusetts. As usual, they planned to audit 100 admissions but then, as they describe, because of the ...
RACMonitor: Shameless -- The Paradox of Healthcare Regulations
Dr. Ronald HirschAugust 18, 2022
Lots to report in this regulatory update.
RACMonitor: CMS Announces New Appeal Rights – Process To Be Determined
Dr. Ronald HirschAugust 12, 2022
Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class action lawsuit. Filed by a group of Medicare beneficiaries, the suit alleged they had to pay out of pocket for skilled nursing care—despite being hospitalized for over three days—because their stay was outpatient and did not meet the ...
