News

The recent study was commissioned by the American Hospital Association and the Federation of American Hospitals. A report released last week found that the federal government has reduced Medicare and Medicaid payments to hospitals by nearly $253 billion, through 12 different legislative actions since 2010. $253 billion.   Two quick…
Providers should keep in mind that such policies aren’t binding – but can offer valuable direction. Imagine your Medicare Administrative Contractor (MAC) had a policy detailing their coverage of records documented by a scribe.  Say that policy had been revoked. You have located a policy by another MAC, CGS. Would it be…
Robert Wood Johnson Foundation commits $6 million; leads two other funders. The industry has been fixated on the funding of services for patients associated with the social determinants of health (SDoH) and the social determinants of mental health (SDoMH), with current efforts particularly focused on steroids. The Robert Wood Johnson…
Therapy hours could go down and depression to go up at SNFs. A depression diagnosis is often hard to make. Clinical depression can be demonstrated in many ways and requires the subjective findings of a clinician. Some clinically depressed individuals seem to withdraw, while others can become irritable or even…
Medicare Advantage plans have reacted to industry criticism of their limited coverage expansion of SdoH. I expected a buzz over our recent Monitor Mondays report and RACmonitor article about the limited coverage expansion of the social determinants of health (SDoH) by Medicare Advantage (MA) plans. Actually, there have been a…
More than 700 pages of text make up proposed changes to the federal Stark and anti-kickback statutes. On Wednesday, Oct. 9, federal healthcare officials announced two new proposed rules.  While the main focus of both proposals is to remove perceived legal barriers to various value-based reimbursement models and facilitate care…
Documentation is essential in order to avoid RAC problems. On the Sept. 9 edition of Monitor Mondays, Dr. John K. Hall made an excellent presentation on the coming Recovery Audit Contractor (RAC) audits of skilled nursing facility (SNF) decision-to-admit proof of skilled need, and how hospital documentation is essential to…
The proposed changes target the federal Physician Self-Referral Law and the Anti-Kickback Statute. The U.S. Department of Health and Human Services (HHS) is introducing proposed changes to “modernize and clarify” the regulations that interpret the Physician Self-Referral Law (the “Stark Law”) and the federal Anti-Kickback Statute, officials announced Wednesday. The…