News

More than two dozen providers are listed as plaintiffs, with more expected to join.   More than two dozen Virginia behavioral healthcare providers have filed a preliminary injunction in federal court to halt and reverse their recent sudden, unexpected dismissal from the state’s Medicaid ranks at the hands of six…
An ad campaign opposing the move is raising eyebrows nationwide. We’re more than halfway into September, but if you’re like me, it feels like 2019 is already over. It doesn’t feel like I’ll have enough time to finish everything I was supposed to before the end of the year. Congress…
Two recent studies indicate more can be done by providers and payers. The healthcare industry continues to devote ample attention to the social determinants of health (SDoH). A minimum of two studies on the topic appear weekly, each yielding the same compelling arguments: Healthcare organizations, providers, and stakeholders could do…
Direct verbal communication between referring and consulting physicians is the best practice. Communicating in the chart, while convenient and useful, rarely provides the most accurate and complete information. The same is true for internal physician advisors – the internal physician advisor is essentially a consultant to the medical staff, providing…
The ruling focused on key hospice admissions. A recent RACmonitor article focused on the AseraCare case, wherein the 11th Circuit Court of Appeals concluded that if reasonable physicians differ about the medical necessity of care, a claim can’t be false. There were two other elements of the case worth emphasizing.…
The ruling marks a stinging rebuke of HHS efforts to steer some services from the hospital outpatient setting to physicians. A federal judge has ruled that a Centers for Medicare & Medicaid Services (CMS) final rule slashing Medicare payments for certain hospital outpatient clinical evaluation and management (E&M) services to…
As Virginia Medicaid behavioral healthcare providers are being terminated, the question remains, is it legal. EDITOR’S NOTE: The opinions expressed herein are exclusively that of the author and do not necessarily reflect that of RACmonitor. Virginia behavioral healthcare providers that accept Medicaid are under statewide blanket fire. Without warning or provocation,…
Since 2010, a total of 113 rural hospitals have closed in the U.S Last week I was honored to be the opening keynote for SEACAA 2019; the annual conference for the Southeastern Association of Community Action Agencies. More than 1,000 of these agencies are on the front lines of the…