SHARE THIS
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...
If you follow politics, you are well aware that there is an ongoing debate between nationalism (primarily concerned with what goes on within a country’s borders) and globalism (trying to optimize outcomes for all nations). I will not wade into this debate, but it got...
Since the onset of the 2-midnight rule, hospitals have been spared the onslaught of medical necessity denials from Recovery Audit Contractors (RACs). The RACs have certainly branched into other areas of audit in hospitals, but tightened claim limits have significantly...
It is a truism that hospital financial outcomes result from an interdependent web of departments contributing specific functions and deliverables, commonly referred to as the revenue cycle. Each silo – admitting, managed care contracting, utilization management,...
By Jerilyn Morrissey, MD Twenty years ago, few hospitals thought of using a physician as a regular resource for utilization review purposes. My colleagues, Drs. Corrato, Zebrowitz, and McCarter introduced the Physician Advisor role to the industry in the early 2000s....
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...
If you follow politics, you are well aware that there is an ongoing debate between nationalism (primarily concerned with what goes on within a country’s borders) and globalism (trying to optimize outcomes for all nations). I will not wade into this debate, but it got...
Since the onset of the 2-midnight rule, hospitals have been spared the onslaught of medical necessity denials from Recovery Audit Contractors (RACs). The RACs have certainly branched into other areas of audit in hospitals, but tightened claim limits have significantly...
It is a truism that hospital financial outcomes result from an interdependent web of departments contributing specific functions and deliverables, commonly referred to as the revenue cycle. Each silo – admitting, managed care contracting, utilization management,...
By Jerilyn Morrissey, MD Twenty years ago, few hospitals thought of using a physician as a regular resource for utilization review purposes. My colleagues, Drs. Corrato, Zebrowitz, and McCarter introduced the Physician Advisor role to the industry in the early 2000s....
CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (CMS-1834-FC) December 2025 Overview On November 21, 2025, CMS issued sweeping reforms in the CY 2026 Hospital Outpatient Prospective Payment System (OPPS)...
Rethinking Healthcare Documentation and Denials for a Better Future Healthcare organizations are moving through one of the most difficult administrative periods the industry has ever seen. Denials are rising, documentation requirements keep expanding, and...
Build a Stronger Bottom Line with our Hospital Budgeting Toolkit Budget season can put health system leaders in a difficult spot. Costs must come down and every dollar has to be justified. But with denials rising, payer demands intensifying, and patient needs growing...
