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…
Issues abound in prominent payer coding guidance. By now, many hospitals have received denials for emergency department level-of-care coding. We could legitimately ask, “how did this happen?” Today we shall address how it started, why it’s important, and potential institutional responses. Denials for emergency care are not new. The spectrum…
There are steps providers should take for holding managed care plans accountable. Considerable effort is regularly devoted by healthcare providers to overcome coverage denials through the application of the governing rules, such as they can be leveraged. Following the rules is tough in a world where money talks, bringing us…
Assigning status to likely terminal patients. I received a great question last week and thought I’d share it with you, our readers. This case management manager wanted to know how to determine status for a patient who came into the ED and was deemed unlikely to live past 24 hours.…
UnitedHealth Group and MEDPAC both reported on the state of emergency departments last week. Last week, emergency departments (EDs) got some serious national attention. First, UnitedHealth Group released a study examining costs associated with freestanding emergency departments (FSEDs), and second, there was a call for the Centers for Medicare &…
Emergency departments (EDs) have been a hot-button topic in the battles over “surprise” billing.  Certainly, many patients use EDs inappropriately. We’ve all read and heard about uninsured patients, patients with no primary care provider, patients who simply abuse the fact that EDs are always open, patients with complaints that are…
Recent issues in Oklahoma, Nebraska portend a growing crisis. The news coming out of Oklahoma was grim: Pauls Valley Regional Medical Center couldn’t keep its doors open, despite a GoFundMe campaign, as well as a reported solicitation from country music star Toby Keith. And in September, Latimer County General Hospital,…
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…
Condition 44 is one of three perplexing issues reviewed by the author.  Last week was a boring regulatory week, other than the continuing talk about the proposed changes to evaluation and management (E&M) coding. That continues to dominate discussions, with ongoing negativity by the physician community. Without new regulatory controversy,…
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