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There is still a lot of confusion regarding the impact on Medicare beneficiaries from eliminating the Inpatient-Only List. As recent as last week, an article from The Washington Post titled New cost-cutting Medicare rule may add costs to patients, discussed how this...
By Joseph Zebrowitz, MD Denials Are Bad…Maybe Not One of the central tenets of utilization management is that “denials are bad.” Our hospitals have developed a myriad of Key Performance Indicators (KPIs) that reflect this: we track denial rate and total number of...
Within the IPPS policy guidance, CMS has finalized an initiative requiring hospitals report payer-specific negotiated charges. Effective January 1, 2021, any hospital operating in the United States is required to provide clear and accessible pricing information about...
Much ado is being made about the addition of Total Knee Arthroplasty (TKA) to the Program for Evaluating Payment Patterns Electronic Report or, as we all know it, the PEPPER. I would add my voice to the “ado,” not because I think this indicates coming scrutiny, but...
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...
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...
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...
There is still a lot of confusion regarding the impact on Medicare beneficiaries from eliminating the Inpatient-Only List. As recent as last week, an article from The Washington Post titled New cost-cutting Medicare rule may add costs to patients, discussed how this...
By Joseph Zebrowitz, MD Denials Are Bad…Maybe Not One of the central tenets of utilization management is that “denials are bad.” Our hospitals have developed a myriad of Key Performance Indicators (KPIs) that reflect this: we track denial rate and total number of...
Within the IPPS policy guidance, CMS has finalized an initiative requiring hospitals report payer-specific negotiated charges. Effective January 1, 2021, any hospital operating in the United States is required to provide clear and accessible pricing information about...
Much ado is being made about the addition of Total Knee Arthroplasty (TKA) to the Program for Evaluating Payment Patterns Electronic Report or, as we all know it, the PEPPER. I would add my voice to the “ado,” not because I think this indicates coming scrutiny, but...
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...
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...
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...
By Angela Sorbelli, J.D., LL.M, MBA, CHC On April 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release detailing the beginning of the phase-out activity for the temporary emergency waivers that have been in effect since the beginning...
By Angela Sorbelli, J.D., LL.M, MBA, CHC The United States has been in a state of Public Health Emergency (PHE) due to the coronavirus pandemic since January 2020. Section 319 of the Public Health Services (PHS) Act grants the authority to declare and re-evaluate the...
Overview In a late 2021 legislative session, Congressional activity resulted in a little bit of breathing room for hospitals after the New Year. In a bipartisan vote by Senate late last week, legislation was passed that mitigates nearly 10% Medicare reimbursement cuts...
