News

Federal agencies warn of pre-symptomatic, asymptomatic viral spread. Federal officials announced this week that they are making payments available to physicians and providers for counseling patients receiving COVID-19 tests about the vital importance of self-isolation prior to the onset of symptoms. The Centers for Medicare & Medicaid Services (CMS) and…
Pressure mounts as members of Congress are poised to leave for their summer recess that begins in August. First, the administration formally extended the Public Health Emergency (PHE) last week. The U.S. Department of Health and Human Services (HHS) had said the agency was planning on extending the PHE; however,…
July 30, 2020

Do We Really Need Multiple Medical Record Reviewers?

By Stefani Daniels, MSN, RN, CMAC, ACM and Tiffany Ferguson, LMSW, ACM
Utilization review (UR) activities have been around for decades. The scope of the activities run the gamut from a backward glance at physician documentation to ensure that the patient’s clinical picture and proposed interventions match the best-practice scenarios promoted by MCG and IQ, to real-time peer review by a team…
Minorities have been found to be disproportionately affected by adverse outcomes. Federal officials say their first monthly statistical update illustrating the impact of the COVID-19 virus on the Medicare population leaves no doubt: minorities are being disproportionately affected by the continuing pandemic.   The Centers for Medicare & Medicaid Services…
The U.S. Department of Justice (DOJ) is deeply committed to combating drug companies’ pervasive practice of disguising patient kickbacks as charity. Most recently, Boston-based prosecutors reached a $51 million settlement with Swiss pharmaceutical giant Novartis, resolving allegations that Novartis coordinated with charitable foundations to steer Medicare patients to its drugs…
July 24, 2020

News Alert: Feds Extend Public Health Emergency

By Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P
Against the backdrop of a nation in the grip of a prolonged pandemic caused by the COVID-19 coronavirus and its rising death toll of more than 143,700 Americans, the federal government late Thursday extended the nation’s public health emergency (PHE), which was due to expire July 25. Health and Human…
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…