July 23, 2020

As Hospitals Relax No-Visitor Policies, Let’s Work to Do Better Next Time

By Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV
Dear hospital administrator/provider who believes you comprehend how terrible the no-visitor policy is: You don’t. Having practiced as a pediatric hospitalist for a decade, I’ve participated in thousands of conversations with patients and family members wherein my goal was to be as straightforward as possible. I try to stick to…
July 23, 2020

Total Joint Replacement Under Scrutiny Again

By Ronald Hirsch, MD
Hospitals are urged to devote the resources to ensure that medical necessity is met, and the proper status is ordered. The attention given to total joint replacement has been a recurring headache for both physicians and hospitals over the last several years, and it appears that there is little chance…
July 23, 2020

SDoH and COVID-19

By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
New report addresses unemployment and insurance challenges amid COVID-19 Unemployment is a hot topic amid the ongoing COVID-19 pandemic, especially within the context of who has health insurance. A recent report by the Urban Institute and sponsored by the Robert Wood Johnson Foundation yielded concerning trends during what is now…
The final sum is slightly greater than the FY 2018 total. The federal government won or negotiated more than $2.6 billion in healthcare fraud adjustments and settlements during the course of the 2019 fiscal year, according to an annual report released Wednesday by the U.S. Department of Health and Human…
July 21, 2020

Nursing Homes – It Is All About Case Mix

By Timothy Powell, CPA CHCP
Based on latest filed Medicare cost reports, a little over 12 percent of all skilled nursing facility or “SNF” patients are Medicare recipients. This is excluding Medicare Advantage patients.  By comparison, over 57 percent of patient days were for Medicaid patients.  It is critical to understand that Medicare pays two…
July 16, 2020

RAC Audits Expected During the COVID Pandemic

By Knicole C. Emanuel Esq.
Even though the public health emergency (“PHE”) for the COVID pandemic is scheduled to expire July 24, 2020, all evidence indicates that the PHE will be renewed. I cannot imagine a scenario in which the PHE is not extended, especially with the sudden uptick of COVID. Center for Medicare and…
July 16, 2020

COVID-19, the SDoH, and Payers

By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
By now the healthcare industry and every stakeholder knows that the pandemic’s impact will be felt indefinitely. However, with escalating numbers of unemployed, and uninsured, I’ve received countless emails from colleagues and our Monitor Mondays listeners asking about how the payers are stepping up? What’s the status of Medicaid expansion?…
July 16, 2020

The Perils of Email

By David M. Glaser, Esq.
Email is a wonderful thing.  As a kid, or even as an adult, I rarely wrote letters because the act of addressing an envelope was too much for me.  (Please don’t judge me too harshly!) But I whip off emails to friends all the time.  While I love email, it…