RACmonitor

Quality reporting will be mandatory in 2024, and then under a payment determination in 2026. Last week I reported on the social determinants of health (SDoH) requirements for 2023, with many Monitor Mondays listeners being familiar with the Z code discussion. However, based on our listener survey, most respondents had not started working on the quality requirements under the social drivers of the health measure.

CMS has implemented two measures under its Hospital Inpatient Quality Reporting program. There is a lot of buzz in the Social Determinants of Health (SDoH) reporting and documenting world, and it is coming from all angles.

This story is in recognition of National Hispanic Heritage Month. The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health has released healthcare materials that are targeted for our Hispanic patient population in honor and support for National Hispanic heritage month.

A decision last week by a Federal Appeals Court could impact the False Claims Act. The Eighth Circuit Court of Appeals, which covers states in the middle part of the country from Minnesota and the Dakotas down to Missouri and Arkansas, concluded that to prevail in a False Claims Act (FCA) case, the relator/government must show that the bills in question would not have been submitted to the government “but for” the kickback. The relator in the case (United States ex rel. Cairns v.

From my June 13 Monitor Mondays segment on the impact of gun violence on healthcare to the time I researched for this segment, there have been 67 deaths and 404 injuries. Since last report, our bloodiest day was July 4, with the Highland Park mass shooting resulting in eight dead and 29 injured. Across the country that day, 11 died and 70 were injured by guns.

CMS is requesting comments on getting better data on the social determinants of health (SDoH). As I am sure you have heard, the inpatient proposed rule for 2023 is out. I have not yet read all 1,786 pages, but I can tell you this– it is terribly boring, but who doesn’t like boring? Sure, there are the usual payment proposals that are of great interest to finance and some code changes that the CDI and coding staff just love, but the Two-Midnight Rule remains intact.

Different states have different rules for pursuing arbitration. The federal arbitration portal for the No Surprises Act (NSA) is now open for business. The portal can be used for providers who want to initiate arbitration related to their NSA reimbursement claims before a third-party entity. While this is good news, providers still must figure out whether they can be reimbursed and pursue arbitration under either the state or the federal rules.

Impact on SNFs was foreseen in the IPPS proposed rule. Last week, the Centers for Medicare & Medicaid Services (CMS) followed up on President Biden’s request to address the quality and delivery of care in skilled nursing facilities (SNFs). CMS issued a proposed rule that would update Medicare payment policies and rates for the 2023 fiscal year, and also introduced proposals for new data requirements for the SNF Quality Reporting program (QRP) and the SNF Value Based Program.

Observation billing for level of care is the strategy that insurance companies are using to hold their costs down. Whether you are part of a not-for-profit or for-profit organization, let’s focus on the care being provided to the insurance card member in this article. I know that observation billing for level of care is the strategy that insurance companies are using to hold their costs down.

Some recent high-profile cases clearly demonstrate neglect, fraud, and abuse. While not new, private equity (PE) interests are buying hospitals and skilled nursing facilities (SNFs) at an increasing pace. Many of the purchasers are physician organizations, and members of Congress are sounding a doomsday alarm about profits being prioritized ahead of patients. Some recent high-profile cases clearly demonstrate neglect, fraud, and abuse. This, however, is not a situation unique to PE ownership.