RACMonitor: Barrows v. Becerra – The Prelude to Another Required Beneficiary Notice?

Dr. Ronald HirschFebruary 4, 2022

Hospitals need to ensure that patients are placed in the right status from the start, so that patients have access to the benefits available to them.

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Outrageous Hospital Charges – Don’t Blame the Hospital

Dr. Ronald HirschFebruary 3, 2022

There has been a lot of media attention to hospital charges recently. With the COVID-19 pandemic, The Centers for Medicare & Medicaid Services (CMS) worked miracles to allow health systems to be paid a facility fee for many remote visits to cover the overhead costs of such visits. The price transparency regulations require more ...

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RACMonitor: CMS Updates Important Message from Medicare Instructions

Dr. Ronald HirschJanuary 25, 2022

The changes will become effective in about three months, giving providers time to modify processes.

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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.

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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.

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RACMonitor: Final Rule Reveals No Surprise

Dr. Ronald HirschNovember 30, 2021

The CMS Two-Midnight rules continues to prompt questions.

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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, making imaging a key source of ...

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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 health emergency. This article ...

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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.

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RACMonitor: Deconstructing the Concept of Condition Code 44

Dr. Juliet Ugarte HopkinsMarch 3, 2021

Dear Readers,

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