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.…
The debate over the controversial two-midnight rule rages on. Ok, I surrender. “This is not the hill I intend to die on” is an accurate metaphor. There has been here at RACmonitor a flurry of concern, debate, troubled investigation, and notice of dodging by health plans, and, as we’ve come…
Contrary to the belief of some, the rule remains alive and well. EDITOR’S NOTE: The rumor mill was churning recently regarding news from a Wisconsin health plan that reportedly was discontinuing adherence to the contentious two-midnight rule of the Centers for Medicare & Medicaid Services (CMS), believing that CMS was,…
Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting…
Latest move by CMS raises more questions. CGS, a Medicare Administrative Contractor (MAC), on Thursday released an email notice indicating that the Centers for Medicare & Medicaid Services (CMS) has instructed it to stop seeking recoupment or issuing demand letters for Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) Hospital…
CMS removed the admission order as a condition of payment effective Oct. 1, 2018. The change in the 2019 Inpatient Prospective Payment System (IPPS) Final Rule concerning the inpatient admission order has created more controversy than I expected. When I read the proposed and final rules, wrote my RACmonitor articles…
Better ED quality measures, and, ultimately, greater patient satisfaction are among benefits cited. The placement of registered nurse (RN) case managers in the emergency department, with a focus on determining appropriate admission status and making status recommendations to admitting physicians, has proven to be very successful at Waukesha Memorial Hospital…
The author responds to comments from readers of his recent RACmonitor article. The May 17, 2018 RACmonitor news article Two-midnight Rule Remains Confusing; Total Knee Replacements Frustrating to Many resulted in several comments before I had even finished my first cup of coffee. Chuck Buck, RACmonitor editor and host of…
Two CMS initiatives continue to cause confusion among healthcare providers EDITOR’S NOTE: The following is a summary of a broadcast segment on Monitor Monday, May 14 by the author. Do you realize that the two-midnight rule has been the law of the land for the last four years, seven months…
Recoupment and one-day inpatient admission for total knee replacement. EDITOR’S NOTE: The following is a summary of a broadcast segment on Monitor Monday, May 7 by the author. While we are still trying to make sense of what the Centers for Medicare & Medicaid Services (CMS) meant with its proposal…
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