Almost 40% of Americans recently reported they were deferring medical care due to the cost of treatment.1 This is particularly true for Americans with low incomes, who have reported cancelling treatment for even the most serious conditions due to an inability to pay for necessary services.
Financial ...
With an extremely compressed timeframe, the Centers for Medicare & Medicaid Services (CMS) released
On the June 5 edition of Monitor Mondays and in a recent RACmonitor news article, Dr. Bonny Olney from Read More
As you may know, several payers have adopted a policy that they will review hospital billing for facility fees for emergency department visits, and will use their proprietary tools to automatically downgrade such visit codes based on the diagnoses and services listed on the claim. But as nearly all surely know, this is not compliant ...
In the United States, prior authorization (“PA”) is a cost-containment tool utilized by payers to reduce payment for medically unnecessary or inappropriate patient care. Despite its laudable policy goals, the use of PA faces
The proposal from the Centers for Medicare & Medicaid Services to codify the requirement that all Medicare Advantage plans use the Two-Midnight Rule for determining admission status of all patients has some talking that the use of commercial criteria will become obsolete. ...
EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor Mondays with Chuck Buck at 10 Eastern.
It is time for another multi-topic update. Some weeks produce just too much news to limit my reporting to one topic.
Complaints are abundant from beneficiaries.
Lots to report in this regulatory update.
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