RACMonitor: Why Too Much News is a Good Thing
Dr. Ronald HirschOctober 18, 2022
It is time for another multi-topic update. Some weeks produce just too much news to limit my reporting to one topic.
RACMonitor: Medicare Advantage -- No Apparent Advantage for Some
Dr. Ronald HirschSeptember 16, 2022
Complaints are abundant from beneficiaries.
RACMonitor: Shameless -- The Paradox of Healthcare Regulations
Dr. Ronald HirschAugust 18, 2022
Lots to report in this regulatory update.
RACMonitor: CMS Announces New Appeal Rights – Process To Be Determined
Dr. Ronald HirschAugust 12, 2022
Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class action lawsuit. Filed by a group of Medicare beneficiaries, the suit alleged they had to pay out of pocket for skilled nursing care—despite being hospitalized for over three days—because their stay was outpatient and did not meet the ...
RACMonitor: Understanding the Medicare Case-By-Case Exception
Dr. Ronald HirschJuly 28, 2022
Exceptions should be never rare nor unusual.
RACMonitor: Will Rural Emergency Hospitals Save Rural Health Care?
Dr. Ronald HirschJuly 22, 2022
All eyes are on the new proposal put forth by CMS to create Rural Emergency Hospitals.
RACMonitor: Issues and Implications - MedPAC to Benchmarks to KPIs
Dr. Ronald HirschJuly 10, 2022
Observations, questions and answers during a week of pontification.
Value-Based Reimbursement: The Future of Healthcare
Brian BellamyJune 28, 2022
Over the past several years, healthcare has begun the move toward the adoption of value-based reimbursement (VBR). The transition is picking up speed as the industry begins to emerge from the COVID pandemic.
HFM: Utilization Review Hurting Results Fixing Inpatient Admissions
Dr. Ronald HirschJune 13, 2022
Since 2004, the Centers for Medicare and Medicaid Services (CMS) has allowed hospitals to change the status of a patient who was improperly admitted as an inpatient to outpatient by following a process commonly known as
RACMonitor: OIG Report on Medicare Advantage Organization Denials
Dr. Ronald HirschMay 11, 2022
The OIG’s determinations seem to fly in the face of the basic concepts of medical necessity.
