News

Article
CMS
Hospital Management
Medicare
Physician Advisory
Dr. Ronald HirschFebruary 20, 2020

New Technology: Price it Right, or Else

There is nothing wrong with adjusting prices to fit your cost-to-charge ratio. New technologies have always posed a financial challenge to hospitals. While they want to provide cutting-edge care to patients, unless a positive margin can be maintained, the costs of those technologies can quickly lead to ...

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Article
CMS
Physician Advisory
Dr. Ronald HirschJanuary 30, 2020

Vertebral Augmentation: Navigating the Unknown to Ensure Payment

The debate over percutaneous vertebral augmentation is continuing in 2020, with the release of a new local coverage determination (LCD) from Noridian – a Medicare Administrative ...

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Article
CMS
Hospital Management
Dr. Ronald HirschJanuary 16, 2020

The Dilemma of the Discharge Planning Conditions of Participation

It was way back in 2015 when the Centers for Medicare & Medicaid Services (CMS) proposed changes to the discharge planning conditions of participation. Their goal was noble; they understood that because discharge planning is a complex process, a successful discharge plan is crucial to reducing the risk of ...

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Article
CMS
Medicare
Dr. Ronald HirschNovember 6, 2019

Service Delivery Fundamentally Changing as ASC Use Accelerates

As advances in surgery continue, more and more procedures are destined for the outpatient arena.

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Article
CMS
Hospital Management
Physician Advisory
Angie StewartJuly 19, 2019

Outmigration of Cardiology - Logistical Challenges for ASCS + How Hospitals are Bracing for Volume Loss

CMS' 2019 Outpatient Prospective Payment System rule cleared the way for some cardiac procedures to be performed in ASCs, creating financial uncertainty for hospitals, according to Ronald Hirsch, MD, vice president of regulations and education group for R1 RCM.

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Blog Post
CMS
denials management
Physician Services
R1 RCMMarch 29, 2019

The Appeal of Appeals: The Process of Appealing a Denied CMS Claim

Since we were all in kindergarten, we have been taught to work out our differences when we disagree. Ultimately, it provides an opportunity for the other side to understand our perspective, and we may even gain some type of ground in the relationship.

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Article
CMS
Hospital Management
Physician Advisory
Dr. Ronald HirschMarch 20, 2019

OIG Audits Part A SNF Stays for Qualifying Inpatient Admissions - And the Results are Not Pretty

The federal watchdog did not, however, decide to demand recoupments.

 

It is said that great minds think alike. And that proved to be true when the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released its report (CMS improperly paid ...

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Article
CMS
Hospital Management
Physician Advisory
Dr. Ronald Hirsch for HFMA’s First Illinois Chapter NewsletterMarch 13, 2019

Future of Hospital Cardiac Programs in Flux - $700,000,000 At Stake

Much of the talk in the last few months has been about the changes proposed by the Centers for Medicare & Medicaid Services (CMS) to the physician evaluation and management code selection and payment regulations in the 2019 Proposed Physician Fee Schedule Rule. And there was a collective national sigh of ...

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Best Practices
Blog Post
CMS
Coding
Ginger MillerNovember 8, 2018

Recognizing the Importance of Innovation in Medical Coding

A significant portion of operational impact, support and overall compliance in healthcare services starts with coding. Medical coding helps the healthcare industry transform diagnoses, physician’s notes, and various medical services into a common language that ensures both the patient, provider and payers receive ...

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Blog Post
CMS
Coding
Medicare
Bill FinerfrockJuly 24, 2018

Major Changes to E/M Coding and Documentation Under 2019 Medicare Physician Fee Schedule Proposed Rule

On July 12th, the Centers for Medicare and Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule (PFS) proposed rule. This annual update to the regulation makes changes to Medicare Part B reimbursements for services covered under this and other outpatient payment models.

...

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