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There is nothing wrong with adjusting prices to fit your cost-to-charge ratio. New technologies have always posed a financial challenge to hospitals. While they want to provide cutting-edge care to patients, unless a positive margin can be maintained, the costs of those technologies can quickly lead to significant financial losses.…
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MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG.  The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a study that should cause a chill to run down the spines of hospital and Medicare Advantage plan leaders alike.…
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Length of stay does not correlate directly with costs. I am sure many of you have heard me rant about observation rates before. I’m sure at least half of you have been told that your observation rate is too high and that you need to fix it. “You’re above the…
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CAR-T therapy could list a single service with a $1.4 million charge. I was honored to be able to speak at the annual meeting of the National Association of Healthcare Revenue Integrity in Arizona in mid-October. Since the audience was a group of hospital revenue staff, I used my session…
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Providers should consider how to optimize the patient’s health status prior to discharge to hospice. In his RACmonitor article of Aug. 8 regarding the recent proposed final rule for inatient amission orders, Dr. Ronald Hirsch reported that the Centers for Medicare & Medicaid Services (CMS) added inpatient transfers to hospice…
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Federal officials said the health system received overpayments of at least $2.4 million from 2014 through 2016. The University of Wisconsin Hospitals and Clinics Authority has found itself the target of an audit by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) for improperly…
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CERT claim review highlights need for strategic approach. How do you handle your appeals when there is more than one issue being denied? For example, if the payer denies both the medical necessity of the level of care as well as the coding of a procedure, what strategies should you…
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Late last week a case management colleague distributed an insurance company memo that had been sent to her hospital to a Recovery Audit Contractor- (RAC)-related user group. This memo required a double-take to ensure that it was not five months old, because it should have been distributed on April Fools’…