Regulatory Insights Archives

Aligning Payor-Provider UR Practices – Proceed with Caution!

by Dr. Joseph Zebrowitz | Mar 12, 2019 | Regulatory Insights

Over the last few years, there has been a trend toward automating the medical necessity UR screening process using software to extract clinical data and either apply commercial criteria or create an acuity score. As I have strolled across trade show floors, I see...

You Can’t Get the Right Answer if You Don’t Ask the Right Question

by Dr. Joseph Zebrowitz | Feb 19, 2019 | Regulatory Insights

In 2013, the Centers for Medicare and Medicaid Services (CMS) finalized the “Two-Midnight” Rule addressing when beneficiary hospitalizations are appropriate for inpatient payment under Medicare Part A. CMS adopted the “Two-Midnight” Rule to simplify the beneficiary...

Vulnerabilities Remain Under Medicare’s 2-Midnight Policy

by Dr. Joseph Zebrowitz | Jan 15, 2019 | Regulatory Insights

In 2016, the Office of the Inspector General (OIG) published a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Policy”, summarizing the first findings of hospital billing patterns since the implementation of the Two-Midnight Rule. The results surprised...

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Aligning Payor-Provider UR Practices – Proceed with Caution!

You Can’t Get the Right Answer if You Don’t Ask the Right Question

Vulnerabilities Remain Under Medicare’s 2-Midnight Policy

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