Costs for testing are being waived as diagnostic tests proceed. EDITOR’S NOTE: The World Health Organization (WHO) has declared that the coronavirus is now a pandemic. With the novel coronavirus (COVID-19) outbreak intensifying across the country and large-scale public gatherings of all types being postponed or canceled en masse, federal officials…
Health systems are grappling with custodial/social admissions from the ED. A specific quandary is playing out in emergency departments (EDs) all over the country, and no one seems to have a clear answer on how to address it. The situation? Patients presenting to EDs because they are unable to care…
It is important to differentiate between ED professional and ED facility coding, and how levels of service are assigned. EDITOR’S NOTE: Recently, RACmonitor published articles referencing UnitedHealthcare/ Optum’s notice that they were changing the way they process emergency department (ED) claims, beginning April 1, 2020, along with how professional and facility…
ED physicians and healthcare providers are a distinct breed – whales in a sea of fish. After all, emergency room doctors have, for the most part, been overlooked by the Recovery Audit Contractor (RAC) auditors (or TPE, Targeted Probe-and-Educate; ZPICs, Zone Program Integrity Contractors; or Medicare Administrative Contractors, MACs). Maybe…
UnitedHealth says it will use proprietary software to deny claims. EDITOR’S NOTE: The topic of this article was previously covered by RACmonitor on separate occasions in 2017 and 2018. To welcome the new year, UnitedHealthcare (UHC) has announced that starting April 1, 2020, they will use a proprietary software program…
EDITOR’S NOTE: Not everyone will be home for the holidays this season. Healthcare doesn’t ever take a holiday. Emergency departments across the country will be prepared to admit patients on Christmas Eve right on through the New Year. Holiday work schedules have been in place for some time now, and…
EDITOR’S NOTE: Not everyone will be home for the holidays this season. Healthcare doesn’t ever take a holiday. Emergency departments across the country will be prepared to admit patients on Christmas Eve right on through the New Year. Holiday work schedules have been in place for some time now, and…
EDITOR’S NOTE: Not everyone will be home for the holidays this season. Healthcare doesn’t ever take a holiday. Emergency departments across the country will be prepared to admit patients on Christmas Eve right on through the New Year. Holiday work schedules have been in place for some time now, and…
EDITOR’S NOTE: CORRECTION:  In the RACmonitor Nov 29, 2019 edition, Dr. Ronald Hirsch noted that resource use data on skilled nursing facilities (SNFs) was not available on the SNF Compare website. Upon further investigation, the resource use data is, in fact, available indirectly from the SNF Compare home page. Subregulatory…
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…
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