News

The CEO of a health center in central Nebraska needed all hands on deck when the global pandemic hit close to home.   The city of Lexington, Nebraska sits just north of a pair of mighty east-west thoroughfares, U.S. Route 30 and Interstate 80, more or less equidistant from the…
July 9, 2020

InterQual v. MCG vs. the Deep Blue Sea 

By Marvin D Mitchell, RN, BSN, MBA
Unabashedly, this is a teaser for an upcoming webinar "How to Outflank Capricious and Arbitrary Medical Necessity Guidelines from Payers" - a deep-dive look to the role and relevance of these two national standards for guiding a hospital’s utilization and denial management efforts.  There’s much to unpack, especially for nurses…
The new coronavirus is linked to 1,502 deaths among residents of nursing homes and assisted-living facilities in Florida, a new state report shows. It’s an increase of 145 deaths in one week. This is particularly sad when we remember the patients that died in the Rehabilitation Center of Hollywood Hills following Hurricane Irma.  While there was…
The dual settlements represent the Department of Justice’s continued crackdown on possible False Claims Act violations. Novartis Pharmaceuticals Corporation reached an over $642 million-dollar agreement to resolve claims of violating the False Claims Act (FCA). The company based out of East Hanover, New Jersey was involved in two settlements. The first…
As some states begin to reopen, others are seeing increasing numbers of COVID-19 cases with hospitals reporting rising ICU utilization and near-capacity conditions. But one thing has not changed throughout the pandemic, the question of when a skilled nursing facility (SNF) or swing bed may accept a patient Part A…
July 2, 2020

CMS Releases COVID-19 Data, with SDoH Front and Center

By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
I’m a longtime fan of “wholistic” healthcare and case management processes, with a “W” as opposed to an “H” for holistic. This approach addresses whole-person care of physical health, behavioral health, and psychosocial circumstances, taking care not to leave any holes in care; it’s an approach that’s even more vital…
Today is the first day that prior authorization is required for Medicare beneficiaries to undergo specific surgeries. Here are the 10 things you need to know about the program. Five types of surgery – blepharoplasty, botulinum toxin injections to the face, panniculectomy, rhinoplasty, and vein ablation – performed on traditional…
June 30, 2020

PHE is an Enigma for Many Providers

By Knicole C. Emanuel Esq.
As of now, the public health emergency (PHE) for the COVID-19 pandemic will expire July 24, 2020, unless it is renewed. Fellow contributor David Glaser and I have both reported on the potential end date of the PHE. Recent intel from Dr. Ronald Hirsh is that the Centers for Medicare…