News

Lessons learned from last year’s Hurricane Florence have helped one North Carolina hospital prepare for Hurricane Dorian. Meanwhile, Florida has responded to the nursing home tragedy caused by Hurricane Irma. EDITOR’S NOTE: Contributing to this story was Timothy Powell, reporting on the tragedy of the Hollywood Hills nursing home. Like…
The legislation raises questions regarding logistics. As residents of the U.S. Southeast prepare for Hurricane Dorian, which is expected to skirt the coast today, bringing with it hurricane-force winds and storm surges, providers there have something else to worry about as well: the MOON (Medicare Outpatient Observation Notice). As reported…
Changes are effective Oct. 1, 2019. With fewer than 30 days remaining before the transition of payment for inpatient rehabilitation facility (IRF) services to the new formula based on the use of Quality Indicator Data, providers should be winding down their preparations and simply fine-tuning processes. Patients discharged on or…
State Legislature has passed a new law to protect due process. You all likely have read the reports by RACmonitor regarding the debacle in New Mexico, wherein 15 behavioral healthcare companies, which comprised providers of 87.5 percent of such services in the state, had their Medicaid reimbursements suspended upon “credible…
Shorter ALOS was associated with increased readmissions. Recently a fellow RAC Relief community member wrote that while 30-day inpatient readmissions had deceased under the HRRP (Hospital Readmission Reduction Program), the number of total hospital encounters, which include ED and observation revisits, have increased. Providers seek to treat and release patients…
HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients. In 2016, there were 15,807 deaths among…
HHS OIG uncovered irregularities in 2016 reimbursements. Payments for hospice services were in the news this week, with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reporting that the Centers for Medicare & Medicaid Services (CMS) had repeatedly paid twice for such services during…
California-based Zing Health latest to join SDoH market of payers. Since 2018, there has been common language introduced by insurers that includes the verbiage “so-and-so is uniquely positioned to address the SDoH (social determinants of health),” all followed by, “with new programming” promising to: Enhance health outcomes; Be customized to…