RACMonitor: CMS Pushes Forward with Guidance on Alzheimer’s Drug
Dr. Ronald HirschJanuary 20, 2022
Clinical trials for the medication showed no significant improvement in patients.
RACMonitor: Terminology Matters – Site of Service and Status
Dr. Ronald HirschDecember 9, 2021
Sudden reversals from CMS on the Inpatient-Only List and Ambulatory Surgical Center Covered Procedures List have infused confusion into the payment process for providers.
RACMonitor: Final Rule Reveals No Surprise
Dr. Ronald HirschNovember 30, 2021
The CMS Two-Midnight rules continues to prompt questions.
Start Preparing Now for the CMS Appropriate Use Criteria (AUC) Program
Maddie CorriganSeptember 28, 2021
The imaging market in the United States is estimated to generate more than $100 billion annually. While approximately 60% of the imaging volume is conducted within hospitals, ...
AAPL: Physician Billing During the COVID-19 Public Health Emergency: Ambiguities Abound
Dr. Ronald HirschJune 14, 2021
The COVID-19 pandemic brought with it an unprecedented number of waivers and regulatory flexibilities that allowed physician practices to continue to provide care to patients in the office and hospital. But with these came significant confusion related to coding of services provided to patients during the public ...
RAC Monitor: Rebilling Non-Medicare Inpatient Claims
Dr. Ronald HirschMarch 26, 2021
It is crucial to understand the differentiation between a denial for lack of medical necessity and a denial for incorrect status.
RACMonitor: Deconstructing the Concept of Condition Code 44
Dr. Juliet Ugarte HopkinsMarch 3, 2021
Dear Readers,
RACMonitor: Leaving Against Medical Advice
Dr. Ronald HirschFebruary 11, 2021
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 ...
RAC Monitor: Medicare Inpatient Pricer Now Available
Dr. Ronald HirschFebruary 3, 2021
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 ...
RACmonitor: One-Day Medicare Inpatient Surgery Admissions
Dr. Ronald HirschDecember 18, 2020
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 ...
