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.

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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 

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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.

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RACMonitor: Latest Development - The Intersection of IPPS and SDoH

Dr. Ronald HirschMay 2, 2022

CMS is requesting comments on getting better data on the social determinants of health (SDoH).

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RACMonitor: When Does a Patient Become an Inpatient?

Dr. Ronald HirschApril 8, 2022

With Medicare regulations, there appears to be no right answer.

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CMSA: Advocacy – Getting Involved and Making a Difference

Dr. Ronald HirschFebruary 27, 2022

Every single day each one of us makes a difference in our work. Whether it is arranging home durable medical equipment, setting up a patient appointment with a physician, helping a patient with a POLST, or arranging meal delivery, your work helps that patient. You do it day in and day out. And sometimes you probably look at your work and think ...

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ACPA Newsletter: Cancelled Surgery – Change the Status?

Dr. Ronald HirschFebruary 9, 2022

The flip flop by CMS on the Inpatient Only List (IOL) has left many with their head spinning, and with good reason. First they remove 298 surgeries from the list, including many where patients always stay over two midnights, leading to education sessions and program redesigns to get status correct. Then CMS says “never mind” and puts most of ...

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RACMonitor: Important Message from Medicare – Answers to Pending Questions

Dr. Ronald HirschFebruary 4, 2022

You have questions, we have answers.

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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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