News

Article
CMS
Physician Advisory

Dr. Ronald HirschNovember 4, 2020

RACmonitor: IRF Care Again in Audit Crosshairs

Last week, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an audit of OSF Saint Francis Medical Center in Peoria, Ill. In this audit, the majority of the errors were once again due to admissions to inpatient rehab that the OIG’s contracted auditor determined were ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschOctober 8, 2020

RACmonitor: New Rule - Providers Required to Transmit Electronically All Records to QIOs

In a provision glossed over by most, the 2021 Inpatient Prospective Payment System (IPPS) Final Rule introduced a requirement that all providers transmit all records to Quality Improvement Organizations (QIOs) via electronic means as of Oct. 1, 2020. As a reminder, the QIOs perform several types of reviews for ...

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Article
CMS
COVID-19
Physician Advisory

Dr. Ronald HirschSeptember 24, 2020

RACMonitor: New Medical Record Compliance Challenges – Payment for COVID-19 and Patient Appeals to the QIO

The Centers for Medicare & Medicaid Services (CMS) is targeting the hospital medical record for added scrutiny.

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Article
CMS
COVID-19
Physician Advisory

Ayla EllisonSeptember 2, 2020

Becker's Hospital Review: CMS to Require Positive COVID-19 Test for Medicare Pay Boost

CMS recently released guidance that includes a new requirement for hospitals to get a Medicare payment boost for caring for patients diagnosed with COVID-19. 

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Article
CMS
Physician Advisory

Dr. Ronald HirschAugust 20, 2020

RACMonitor: The Demise of the Medicare Inpatient-Only List – The Myths and Facts

Medicare’s often-misunderstood inpatient-only list may soon be departing, as the Centers for Medicare & Medicaid Services (CMS) has proposed to eliminate it over the next three years, as outlined in the 2021 Outpatient ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschAugust 11, 2020

Clinical Practice Today: What Should Physicians Know About the New CMS Rule on Discharge Planning?

In September 2019, the Centers for Medicare & Medicaid Services (CMS) released a new rule on discharge planning, which stems from the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Much less prescriptive than the requirements originally proposed, the final rule increases access to ...

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Article
CMS
Physician Advisory

Dr. Ronald HirschAugust 6, 2020

RACMonitor: CMS Opens Door to G0463 Billing for Remote Physician Visits

The confusion over what code to use when hospital-employed physicians perform virtual visits with patients has reared its head again in 

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Article
CMS
Physician Advisory

Dr. Ronald HirschJuly 24, 2020

RACMonitor: Total Joint Replacement Under Scrutiny Again

Hospitals are urged to devote the resources to ensure that medical necessity is met, and the proper status is ordered. The attention given to total joint replacement has been a recurring headache for both physicians and hospitals over the last several years, and it appears that there is little chance of ...

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Article
Physician Advisory
Prior Authorization

Dr. Ronald HirschJuly 6, 2020

RACMonitor: 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

RACMonitor: 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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