A Perfect Storm: Agencies Collaborate on Medical Debt, Price Transparency, Charity Care
Kathryn Beard, JDAugust 17, 2023
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 ...
Breaking News: Medicare Advantage Must Follow Two-Midnight Rule
Dr. Ronald HirschJuly 24, 2023
With an extremely compressed timeframe, the Centers for Medicare & Medicaid Services (CMS) released
All Healed Up with Nowhere to Go
Dr. Ronald HirschJuly 24, 2023
On the June 5 edition of Monitor Mondays and in a recent RACmonitor news article, Dr. Bonny Olney from Read More
Non-compliant Payers: “Hello, CMS, Are You Listening?”
Dr. Ronald HirschMay 2, 2023
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 ...
Why Prior Authorization Reform Should Garner Provider Support
R1 Regulatory TeamApril 14, 2023
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
A Post-Mortem on Medical Necessity Criteria – Not So Fast
Dr. Ronald HirschFebruary 24, 2023
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. ...
RACmonitor: Warning: Medicare Rates Up in 2023
Dr. Ronald HirschJanuary 27, 2023
EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor Mondays with Chuck Buck at 10 Eastern.
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.
