News

Article
Physician Advisory
Prior Authorization

Dr. Ronald HirschJuly 6, 2020

Medicare Prior Authorization Program – 10 Things to Know

Today is the first day that prior authorization is required for Medicare beneficiaries to undergo specific surgeries. Here are the 10 things you need to know about the program.

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Article
Physician Advisory
Prior Authorization

Dr. Ronald HirschJune 18, 2020

Prior Authorization for Medicare Two Weeks Away

We are two weeks away from the start of the Medicare prior authorization program, and as of June 17, the Medicare Administrative Contractors (MACs) were required to start accepting requests.

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Article
COVID-19
Hospital Management
Physician Advisory

Dr. Ronald HirschMay 28, 2020

RACMonitor: ASC Partnership as a Hospital Without Walls

Everyone is anxious for life to return to normal, but none more than those patients who had planned to have surgery in March or April, but had their surgery cancelled due to the COVID-19 pandemic. These patients have conditions that warrant surgery, but were deemed not to be urgent or emergent, and therefore ...

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Article
CMS
COVID-19
Physician Advisory

Dr. Ronald HirschMay 26, 2020

RACMonitor: Confusion Remains over Medicare Guidance on Treating Patient Homes as Hospital Departments

There is continued confusion over the use of patient homes as off-campus, provider-based clinics for Medicare billing purposes. This is the provision in the Centers for Medicare & Medicaid Services’ (CMS’s) second recent Interim Final Rule (IFR) that allows hospitals to bill for services provided by employed ...

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Article
COVID-19
Physician Advisory

Dr. Ronald HirschApril 19, 2020

RACMonitor: SNF-Eligible Patients with Nowhere to Go

With this pandemic new issues seem to appear daily. The increasing difficulty with skilled nursing facility (SNF) placement led me to write this article and it appears to have struck a chord with many. As with research into medical interventions, the timeline for contemplating, writing, and editing has shrunk ...

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Article
COVID-19
Physician Advisory

Dr. Ronald HirschApril 15, 2020

RACMonitor: The COVID-19 Victims We Aren’t Discussing

The exact number of deaths from COVID-19 is an area of uncertainty. In the midst of a pandemic, data reporting is likely far down on the list of crucial activities. It remains unclear how to count the death of a patient who dies with evidence of infection by coronavirus, but was never diagnosed with COVID-19. ...

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Article
CMS
COVID-19
Physician Advisory

Dr. Ronald HirschApril 9, 2020

RACMonitor: CMS Clarifies Patient Financial Responsibility for COVID-19 Testing

RACmonitor.com news asked Dr. Ronald Hirsch, vice president at R1 RCM, to summarize the latest from the Centers for Medicare & Medicaid Services (CMS) on covering costs for COVID-19 care. In response, Dr. Hirsch provided RACmonitor the following summary.

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Article
CMS
COVID-19
Physician Advisory

Chuck BuckMarch 31, 2020

RACMonitor: CMS Modifies Discharge Planning for Hospitals

As hospitals continue in their struggle to treat patients for COVID-19, the illness caused by the novel coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) has modified its requirements for discharge planning.

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Article
CMS
Hospital Management
Medicare
Physician Advisory

Dr. Ronald HirschFebruary 20, 2020

RACMonitor: Price New Technology Right, or Else

There is nothing wrong with adjusting prices to fit your cost-to-charge ratio. New technologies have always posed a financial challenge to hospitals. While they want to provide cutting-edge care to patients, unless a positive margin can be maintained, the costs of those technologies can quickly lead to ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschJanuary 30, 2020

RACMonitor: Navigating the Unknown to Ensure Payment

The debate over percutaneous vertebral augmentation is continuing in 2020, with the release of a new local coverage determination (LCD) from Noridian – a Medicare Administrative ...

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