The two-midnight rule has brought some clarity to the definition of inpatient status. The new rule certainly reduced the number of stays eligible for admission, so it functionally implemented a reimbursement reduction. But there is no disputing that the new rule is clearer than the preexisting guidance. Still, the poorly written guidance that was replaced by the two-midnight rule offers some vital lessons. Whether or not you still have pending short-stay …Read more
Ever since the Office of Inspector General (OIG) raised the topic of “frequent filers” in its 2012 report, “Improvements Needed at the Administrative Law Judge Level of Medicare Appeals,” there has been a steady swell of distaste for this subtype of appellant. While there is no standing definition for frequent filers, the OIG defined them in the report as those providers who “file appeals much more frequently than others.”1 As a …Read more
The two-midnight rule was supposed to draw a clear line between inpatient and outpatient hospital billing. But the implementation of this defined time frame was not so clear. I believe the two-midnight rule should be replaced. Here’s why and how: Under the rule, the requirement for inpatient admission and Part A billing is medically necessary hospital care that includes two consecutive midnights of service. That seems very simple, but the denial …Read more
I’m not sure how many people paid attention to the sad news over Memorial Day weekend, but Dr. John Forbes Nash Jr., a brilliant mathematician, economist, and one of those few people who made substantial contributions to the way our society works, died in a tragic automobile accident on the New Jersey Turnpike. He and his wife were ejected from...Read more
So your hospital was selected to participate in the bundled payments program. You are participating in “Model 2” of the bundled payments initiative. In Model 2, the episode of care includes the inpatient stay in the acute-care hospital and all related services rendered during the episode for up to 90 days after the patient is discharged. You decided to pick...Read more
One of the worst things to happen to our elders is when their health starts to steadily decline. I am there with my mother. She is 89 years old and has pretty significant dementia. To an ER that is what they see: an 89-year-old with dementia. I am sure their antennae go up: Alert, alert, this could be a social...Read more
For 2015 CMS released a new subset of modifiers to replace (in most instances) use of the familiar -59 modifier. Without official guidance from CMS, hospitals have struggled to make sense of recommendations from various payers and professional organizations.
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