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: When Does a Patient Become an Inpatient?
Dr. Ronald HirschApril 8, 2022
With Medicare regulations, there appears to be no right answer.
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 ...
Court Vacates No Surprises Act Regulations Favoring Payors in Reimbursement Disputes
Kathryn BeardFebruary 25, 2022
On February 23, 2022, a Texas district court found that portions of the No Surprises Act ...
RACMonitor: CMS Updates Important Message from Medicare Instructions
Dr. Ronald HirschJanuary 25, 2022
The changes will become effective in about three months, giving providers time to modify processes.
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.
ICD10monitor: Malnutrition Now on PEPPER
Dr. Ronald HirschDecember 20, 2021
Auditors appear to be hungry to deny.
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.
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.
RACMonitor: Final Rule Reveals No Surprise
Dr. Ronald HirschNovember 30, 2021
The CMS Two-Midnight rules continues to prompt questions.
