News

With a sea of SDoH reports, what will it take to yield change? America’s Health Insurance Plans (AHIP) recently announced its newest initiative, Project Link. The intent of this well-aimed effort is to address those social and non-clinical issues that can’t simply be addressed by a prescription pad: the social…
Mental health represents the latest dimension of the SDoH. EDITOR’S NOTE: This topic was covered by Ms. Fink-Samnick during her featured appearance on the most recent edition of Monitor Mondays. Mental health condition incidence has trended upward for years, especially for populations at risk of issues associated with the social…
OMHA’s new eligibility requirements are intended to benefit more providers. The Office of Medicare Hearings and Appeals (OMHA) has expanded its Settlement Conference Facilitation (SCF) program, and it is now open to the appellant community. By way of background, Settlement Conference Facilitation (SCF) is an alternative dispute resolution process designed…
Work requirements appear to be ineffective. At present, 37 states and the District of Columbia have passed Medicaid expansion. All 50 states may not agree on the concept of expansion, yet they share one point of consensus. The reality of high numbers of enrollees dealing with complex health and behavioral…
This case of goes beyond DSH payments. Earlier this month the U.S. Supreme Court decided an appeal brought by Allina and many other hospitals challenging the methodology the government used when calculating disproportionate share payments. But even if this sounds irrelevant, don’t stop reading, because this decision will have an…
Understanding why there’s a need for auditing the auditors. I frequently encounter complaints by healthcare providers that when they are undergoing Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), and, more recently, the Targeted Probe-and-Educate (TPE) audits, the auditors are getting it wrong. That’s as in, during a RAC audit,…
Trump’s Executive Order will include a requirement to disclose contracted rates. U.S. Health and Human Services (HHS) Secretary Azar and White House officials held a meeting this morning to explain an executive order that the President plans on releasing today on healthcare price transparency.   Officials said that the executive…
There’s an updated version of the IRF-PAI manual. As we prepare for changes in how inpatient rehabilitation facilities (IRFs) are paid through the utilization of quality indicator data rather than Functional Independence Measure (FIMTM) scores to classify patients into appropriate case-mix groups (CMGs), it’s important that IRFs provide the most…