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.

Read More

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.

Read More

RACMonitor: Final Rule Reveals No Surprise

Dr. Ronald HirschNovember 30, 2021

The CMS Two-Midnight rules continues to prompt questions.

Read More

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, ...

Read More

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 ...

Read More

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.

Read More

RACMonitor: Deconstructing the Concept of Condition Code 44

Dr. Juliet Ugarte HopkinsMarch 3, 2021

Dear Readers,

Read More

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 ...

Read More

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 ...

Read More

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 ...

Read More