News

Article
CMS
Denials Management
Physician Advisory

Dr. Ronald HirschMarch 26, 2021

RAC Monitor: Rebilling Non-Medicare Inpatient Claims

It is crucial to understand the differentiation between a denial for lack of medical necessity and a denial for incorrect status.

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Article
CMS
COVID-19
Physician Advisory

Dr. Juliet Ugarte HopkinsMarch 3, 2021

RACMonitor: Deconstructing the Concept of Condition Code 44

Dear Readers,

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Article
CMS
Hospital Management

Dr. Ronald HirschFebruary 11, 2021

RACMonitor: Leaving Against Medical Advice

Against Medical Advice: Are A M A Scarlet Letters?

A recent discussion on Twitter caught my attention. A physician posted, “Left against medical advice” is not the same as ‘Left to attend sister’s funeral.’ Let’s choose our words better.” This doctor has a point. The choice of words we use to ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschFebruary 3, 2021

RAC Monitor: Medicare Inpatient Pricer Now Available

When I teach Medicare regulations to physician advisors, case managers, and utilization review professionals, it is always interesting to see the reactions when I explain how Medicare calculates how much to pay for an inpatient admission. Most are aware of the Medicare Severity Diagnosis-Related Group (DRG) system ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschDecember 18, 2020

RACmonitor: One-Day Medicare Inpatient Surgery Admissions

The CMS proposal to eliminate the Inpatient-Only List, does not mean that all procedures are to be performed as outpatient. On Jan. 18, 2018, RACmonitor published my article titled “CMS Says OK to Admit Total Knee Replacements as Inpatient.” The title created a bit of an uproar, as many thought I was conveying ...

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CMS
Podcast
Price Transparency
Revenue Cycle

Ogi KwonDecember 17, 2020

HFMA: The Benefits of Going Beyond Price Transparency Compliance

The price transparency deadline is right around the corner, but the story doesn't end come January 1. Compliance with the price transparency rule is a big task for hospitals, and there's a big difference between compliance and maintaining good patient financial communication.

 

Ogi Kwon, ...

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Article
CMS
Price Transparency
Revenue Cycle

Ogi Kwon & Kathryn BeardDecember 16, 2020

Physicians Practice: Preparing for Price Transparency

The most successful physician groups anticipate trends and incorporate necessary changes into their practice culture. From protecting patient data to ensuring compliant billing, practices that understand regulatory requirements and proactively create an environment that fosters compliance enjoy greater ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschDecember 3, 2020

RACmonitor: CMS Accepts Waivers for At-Home Services

During a short Thanksgiving work week, the Centers for Medicare & Medicaid Services (CMS) found time to make two pretty significant announcements. The first is that they are now accepting waiver requests from hospitals to offer true at-home services. In this program, instead of admitting patients requiring ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschDecember 1, 2020

RACmonitor: Total Knee Replacement Added to PEPPER

In the midst of a pandemic, the Centers for Medicare & Medicaid Services (CMS) has decided the time is right to add a new element to the quarterly Program for Evaluating Payment Patterns Electronic Report (PEPPER). This new target area will report the percentage of total knee arthroplasties that were done ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschNovember 4, 2020

RACmonitor: IRF Care Again in Audit Crosshairs

Last week, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an audit of OSF Saint Francis Medical Center in Peoria, Ill. In this audit, the majority of the errors were once again due to admissions to inpatient rehab that the OIG’s contracted auditor determined were ...

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