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These waivers, known as 1135 waivers (due to being granted by Section 1135 of the Social Security Act), are allowed when 2 conditions are met: First, there must be a declaration of a Public Health Emergency (PHE) by the Secretary of the Department of Health and Human...
Five hospital outpatient department (OPD) services will require prior authorization when provided on or after July 1, 2020. These services include: Blepharoplasty Botulinum toxin injections Panniculectomy Rhinoplasty Vein ablation What is prior authorization as it...
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued separate announcements last week that I think will interest you. HHS Updates HHS announced two additional distributions from the Coronavirus Aid,...
The $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act includes more than $100 billion in aid in a Provider Relief Fund for healthcare organizations. In recent weeks, the Department of Health and Human Services (HHS) has issued guidelines on how...
Blanket Waiver of the Utilization Review Standards of the Condition of Participation Does NOT Waive Beneficiary Rights & Condition Code 44 Billing Requirements! Last week, the Centers for Medicare and Medicaid Services (CMS) waived “the entire utilization...
By Jerilyn Morrissey, MD and Jay Ahlmer, CFA As COVID-19 case volumes continue to grow and hospitals prepare for an anticipated patient surge, the stress on healthcare facilities to weather an unprecedented health and financial crisis has skyrocketed. While the $2...
Versalus Health’s Comments on CMS’ Waivers to Utilization Review Conditions of Participation On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) published additional blanket waivers in response to the COVID-19 pandemic. There are a number of...
COVID-19-Related Considerations When Determining Medicare & Medicare Advantage Admission Status 1. Public Health Emergency Declarations As utilization review and compliance experts within your hospitals, it is imperative that you understand the impact that waivers...
Versalus Health’s Comments on CMS’ Revisions to Requirements for Discharge Planning for Hospitals On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) published a new Final Rule, Revisions to Discharge Planning Requirements (CMS-3317-F). The...
As payers become more sophisticated and aggressive in their audit and denial activity, many hospitals have struggled to keep pace. Operational silos and departmental driven metrics lead to disjointed, labor intensive, and ultimately unsuccessful efforts. These efforts...
These waivers, known as 1135 waivers (due to being granted by Section 1135 of the Social Security Act), are allowed when 2 conditions are met: First, there must be a declaration of a Public Health Emergency (PHE) by the Secretary of the Department of Health and Human...
Five hospital outpatient department (OPD) services will require prior authorization when provided on or after July 1, 2020. These services include: Blepharoplasty Botulinum toxin injections Panniculectomy Rhinoplasty Vein ablation What is prior authorization as it...
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued separate announcements last week that I think will interest you. HHS Updates HHS announced two additional distributions from the Coronavirus Aid,...
The $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act includes more than $100 billion in aid in a Provider Relief Fund for healthcare organizations. In recent weeks, the Department of Health and Human Services (HHS) has issued guidelines on how...
Blanket Waiver of the Utilization Review Standards of the Condition of Participation Does NOT Waive Beneficiary Rights & Condition Code 44 Billing Requirements! Last week, the Centers for Medicare and Medicaid Services (CMS) waived “the entire utilization...
By Jerilyn Morrissey, MD and Jay Ahlmer, CFA As COVID-19 case volumes continue to grow and hospitals prepare for an anticipated patient surge, the stress on healthcare facilities to weather an unprecedented health and financial crisis has skyrocketed. While the $2...
Versalus Health’s Comments on CMS’ Waivers to Utilization Review Conditions of Participation On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) published additional blanket waivers in response to the COVID-19 pandemic. There are a number of...
COVID-19-Related Considerations When Determining Medicare & Medicare Advantage Admission Status 1. Public Health Emergency Declarations As utilization review and compliance experts within your hospitals, it is imperative that you understand the impact that waivers...
Versalus Health’s Comments on CMS’ Revisions to Requirements for Discharge Planning for Hospitals On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) published a new Final Rule, Revisions to Discharge Planning Requirements (CMS-3317-F). The...
As payers become more sophisticated and aggressive in their audit and denial activity, many hospitals have struggled to keep pace. Operational silos and departmental driven metrics lead to disjointed, labor intensive, and ultimately unsuccessful efforts. These efforts...
Level the Playing Field: How Payers Keep Denial Rates High, and What to Do About itMore than 25 years ago, on a day like any other, when Dr. Jerilyn Morrissey (now Chief Medical Officer at CorroHealth) was just a new physician and documentation was a pen-to-paper...
WISeR (Wasteful and Inappropriate Service Reduction) Model November 2025 Overview CMS has the responsibility to protect the Medicare Trust Funds, and routinely analyzes data associated with all facets of the Medicare program. A 2020 analysis of claims submitted by...
How AI Is Helping Hospitals Work Faster, Smarter, and with Greater PrecisionWhen health systems talk about clinical documentation improvement (CDI), one challenge consistently rises to the top: there simply aren’t enough people to keep up. Understaffed CDI teams...
