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.
Article
CMS
COVID-19
Physician Advisory
Dr. Juliet Ugarte HopkinsMarch 3, 2021
RACMonitor: Deconstructing the Concept of Condition Code 44
Dear Readers,
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 ...
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 ...
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 ...
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, ...
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 ...
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 ...
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 ...
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 ...
