RACMonitor: CMS Pushes Forward with Guidance on Alzheimer’s Drug

Dr. Ronald HirschJanuary 20, 2022

Clinical trials for the medication showed no significant improvement in patients.

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ICD10monitor: Malnutrition Now on PEPPER

Dr. Ronald HirschDecember 20, 2021

Auditors appear to be hungry to deny.

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RACMonitor: Terminology Matters – Site of Service and Status

Dr. Ronald HirschDecember 9, 2021

Sudden reversals from CMS on the Inpatient-Only List and Ambulatory Surgical Center Covered Procedures List have infused confusion into the payment process for providers.

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RACMonitor: To Practice or Not to Practice – The Physician Question

Dr. Ronald HirschNovember 30, 2021

To be a full-time physician advisor, an individual must give up their regular clinical medical practice.

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RACMonitor: Final Rule Reveals No Surprise

Dr. Ronald HirschNovember 30, 2021

The CMS Two-Midnight rules continues to prompt questions.

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HFMA NJ Chapter Journal: Keep Your Eye on the Ball - Fee Schedules are Missing the Mark

Dr. Ronald HirschOctober 19, 2021

When the Centers for Medicare & Medicaid Services (CMS) finalized the 2021 Outpatient Prospective Payment System Final Rule, they included their plan to abolish the inpatient-only list over the next four years, starting this year with the removal of all orthopedic procedures and ...

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Journal of AHIMA: Appeals, Denials, HIM and Utilization Review - A Winning Combination

Dr. Ronald HirschAugust 23, 2021

Many claim that people in the United States have access to the best healthcare in the world. And while that is easily refuted with data from multiple sources, there is no question that the United States has one of the most complex healthcare delivery systems in the ...

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RACMonitor: New Drug Makes a Splash – A Swan Dive or a Belly Flop?

Dr. Ronald HirschJune 17, 2021

The soaring cost of new medications and technologies is not news. Insulin was first patented in 1923, but due to incremental changes in the molecule and delivery system, a vial of insulin can still cost hundreds of dollars. When highly active antiretroviral therapy was approved for treatment of HIV in the ...

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RAC Monitor: Rebilling Non-Medicare Inpatient Claims

Dr. Ronald HirschMarch 26, 2021

It is crucial to understand the differentiation between a denial for lack of medical necessity and a denial for incorrect status.

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RACMonitor: Deconstructing the Concept of Condition Code 44

Dr. Juliet Ugarte HopkinsMarch 3, 2021

Dear Readers,

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