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Will Medicare Beneficiaries pay more for a procedure no longer on the Inpatient-Only List?
There is still a lot of confusion regarding the impact on Medicare beneficiaries from eliminating the Inpatient-Only List. As recent as last week, an article from The Washington Post titled New cost-cutting Medicare rule may add costs to patients, discussed how this...
Do More Denials Mean More Revenue?
By Joseph Zebrowitz, MD Denials Are Bad…Maybe Not One of the central tenets of utilization management is that “denials are bad.” Our hospitals have developed a myriad of Key Performance Indicators (KPIs) that reflect this: we track denial rate and total number of...
Hospital Price Transparency: Penalties Potentially Much Higher Than Hospitals Anticipate
Within the IPPS policy guidance, CMS has finalized an initiative requiring hospitals report payer-specific negotiated charges. Effective January 1, 2021, any hospital operating in the United States is required to provide clear and accessible pricing information about...
The Addition of Total Knee Arthroplasty (TKA) to the PEPPER Will Be of Little Use to Hospitals
Much ado is being made about the addition of Total Knee Arthroplasty (TKA) to the Program for Evaluating Payment Patterns Electronic Report or, as we all know it, the PEPPER. I would add my voice to the “ado,” not because I think this indicates coming scrutiny, but...
1135 Waivers: When do they expire?
These waivers, known as 1135 waivers (due to being granted by Section 1135 of the Social Security Act), are allowed when 2 conditions are met: First, there must be a declaration of a Public Health Emergency (PHE) by the Secretary of the Department of Health and...
Medicare Update: Prior Authorization Request Process for Certain Hospital Outpatient Services
Five hospital outpatient department (OPD) services will require prior authorization when provided on or after July 1, 2020. These services include: Blepharoplasty Botulinum toxin injections Panniculectomy Rhinoplasty Vein ablation What is prior authorization as it...
COVID-19: Additional $25 Billion CARES Act Fund Allocation & CMS Re-opening Guidelines
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued separate announcements last week that I think will interest you. HHS Updates HHS announced two additional distributions from the Coronavirus Aid,...
COVID-19 CARES Act: Provider Relief Fund Allocation
The $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act includes more than $100 billion in aid in a Provider Relief Fund for healthcare organizations. In recent weeks, the Department of Health and Human Services (HHS) has issued guidelines on how...
COVID-19 CARES Act: Hospitals Must Proceed Carefully
By Jerilyn Morrissey, MD and Jay Ahlmer, CFA As COVID-19 case volumes continue to grow and hospitals prepare for an anticipated patient surge, the stress on healthcare facilities to weather an unprecedented health and financial crisis has skyrocketed. While the $2...
Improving Hospital Performance: A Counterintelligence Operation
As payers become more sophisticated and aggressive in their audit and denial activity, many hospitals have struggled to keep pace. Operational silos and departmental driven metrics lead to disjointed, labor intensive, and ultimately unsuccessful efforts. These efforts...
Will Medicare Beneficiaries pay more for a procedure no longer on the Inpatient-Only List?
Do More Denials Mean More Revenue?
Hospital Price Transparency: Penalties Potentially Much Higher Than Hospitals Anticipate
The Addition of Total Knee Arthroplasty (TKA) to the PEPPER Will Be of Little Use to Hospitals
1135 Waivers: When do they expire?
Medicare Update: Prior Authorization Request Process for Certain Hospital Outpatient Services
COVID-19: Additional $25 Billion CARES Act Fund Allocation & CMS Re-opening Guidelines
COVID-19 CARES Act: Provider Relief Fund Allocation
COVID-19 CARES Act: Hospitals Must Proceed Carefully
