News

Article
CMS
COVID-19
Physician Advisory

Dr. Ronald HirschMay 26, 2020

RACMonitor: Confusion Remains over Medicare Guidance on Treating Patient Homes as Hospital Departments

There is continued confusion over the use of patient homes as off-campus, provider-based clinics for Medicare billing purposes. This is the provision in the Centers for Medicare & Medicaid Services’ (CMS’s) second recent Interim Final Rule (IFR) that allows hospitals to bill for services provided by employed ...

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Automation
Blog Post
CMS
COVID-19
Patient Experience

Joe PolarisMay 18, 2020

Elective Services Volume is Not Guaranteed

Speed to innovate must never be the same again in healthcare. We can identify, analyze, and act to address opportunities quickly and must do so in a new healthcare world that will require a delicate blend of agility and compassion.” - Jason Wolf, CEO, The Beryl Institute, ...

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Article
CMS
COVID-19
Physician Advisory

Dr. Ronald HirschApril 9, 2020

RACMonitor: CMS Clarifies Patient Financial Responsibility for COVID-19 Testing

RACmonitor.com news asked Dr. Ronald Hirsch, vice president at R1 RCM, to summarize the latest from the Centers for Medicare & Medicaid Services (CMS) on covering costs for COVID-19 care. In response, Dr. Hirsch provided RACmonitor the following summary.

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Article
CMS
COVID-19
Physician Advisory

Chuck BuckMarch 31, 2020

RACMonitor: CMS Modifies Discharge Planning for Hospitals

As hospitals continue in their struggle to treat patients for COVID-19, the illness caused by the novel coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) has modified its requirements for discharge planning.

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Article
CMS
Hospital Management
Medicare
Physician Advisory

Dr. Ronald HirschFebruary 20, 2020

RACMonitor: Price New Technology 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

RACMonitor: 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

RACMonitor: 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

RACMonitor: 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

R1 RCMJuly 19, 2019

Becker's Hospital Review: Why the Outmigration of Cardiology Means Challenges for ASCs, Hospital 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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