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.

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RACMonitor: Medicare Advantage -- No Apparent Advantage for Some

Dr. Ronald HirschSeptember 16, 2022

Complaints are abundant from beneficiaries.

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RACMonitor: Shameless -- The Paradox of Healthcare Regulations

Dr. Ronald HirschAugust 18, 2022

Lots to report in this regulatory update.

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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 ...

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RACMonitor: Understanding the Medicare Case-By-Case Exception

Dr. Ronald HirschJuly 28, 2022

Exceptions should be never rare nor unusual.

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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.

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RACMonitor: Issues and Implications - MedPAC to Benchmarks to KPIs

Dr. Ronald HirschJuly 10, 2022

Observations, questions and answers during a week of pontification. 

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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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