Texas Judge Vacates No Surprises IDR Fee Increase, Batching Rule

Kathryn Beard, JDAugust 9, 2023

Disclaimer: This information is for educational purposes only and is current as of August 8, 2023. Not intended to be used as or constitute legal or medical advice.  


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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. ...

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RACMonitor: When Does a Patient Become an Inpatient?

Dr. Ronald HirschApril 8, 2022

With Medicare regulations, there appears to be no right answer.

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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 ...

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Court Vacates No Surprises Act Regulations Favoring Payors in Reimbursement Disputes

Kathryn Beard, JDFebruary 25, 2022

On February 23, 2022, a Texas district court found that portions of the No Surprises Act ...

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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.

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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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