News

By now we’ve all heard the words “anyone who wants a COVID test can have one.” Occasionally, that claim is followed by the word “free,” or “no copay or deductible.” Such statements make great news and sound bites, but it leaves people like me wondering: where’s the catch? Accepting a…
Medicare spending on acute-care inpatient hospital services will increase by about $3.5 billion in FY 2021 As the healthcare industry continues to be buffeted by the unrelenting coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) has released the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital…
Providers forced to camouflage in mediocrity.  EDITOR’S NOTE: This the first in a series of articles that explores the use of algorithms in the auditing of medical claims. The Centers for Medicare & Medicaid Services (CMS) has pioneered the use of computer algorithms for detection of fraud. These efforts leverage technologies…
During this week’s Monitor Mondays broadcast, Ronald Hirsch, MD, vice president at R1 RCM, reminded listeners how confusing all the waivers and flexibilities associated with the COVID-19 pandemic have been, while noting that what is more amazing is that the confusion hasn’t stopped. The latest confusion, Hirsch said, relates to…
This article will explore Medicaid expansion during COVID-19. We all know that COVID has uprooted our lives. Telehealth is the new post-COVID norm, whereas it was in infancy pre-COVID. Perhaps the pandemic has spurred on Medicaid expansion as well. I would be remiss if I did not mention that increased…
Over the course of the continuing COVID-19 pandemic, one topic has mysteriously fallen under the radar. It’s something that greatly impacts health outcomes, and especially virus transmission rates. The Joint Commission identified this issue in 2008 as among the most important factors to impact population health. Any ideas? One final…
EDITOR’S NOTE: This article, originally published on RACmonitor and ICD10monitor, has been updated to alert facilities that COVID-19 testing inclusions will have a fiscal impact starting Sept. 1, 2020. Effective Sept. 1, the Centers for Medicare & Medicaid Services (CMS) has enlisted a mandate requiring hospitals to have positive COVID-19…
The CARES Act included provisions mandating reporting of test results. Federal officials announced a set of sweeping regulatory changes for nursing homes nationwide this week, an expected move considering the disproportionate impact the continuing COVID-19 pandemic has had on such facilities since its onset earlier this year. The Centers for…