Articles and Blogs

In a previous article, we reported on new billing edits that CMS is implementing, which will Return to Provider any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare-enrolled location identified in Provider Enrollment, Chain and Ownership System (“PECOS”). Those edits were scheduled to be activated... READ MORE

NATIONAL BPCI Advanced loses 252 providers, 35% of lower extremity major joint replacement participants Why hospital associations are dipping their toes into state-based Medicare ACOs 1 in 5 Catholic hospitals don’t share religious affiliation online, study finds FDA Chief Scott Gottlieb Calls for Tighter Regulations on Electronic Health Records How states are using Medicare... READ MORE

For nearly 30 years, Palm Valley Cinema provided the community of Goodyear, Arizona with the biggest, newest Hollywood movie releases, from Saving Private Ryan to Rogue One: A Star Wars Story, until it closed in 2016. However, new plans for the cinema will be focused on saving patients rather than providing a source of... READ MORE

NATIONAL How Haven’s hires hint at the healthcare organization’s larger ambitions Medicaid work requirements could cost hospitals $3.7B Outpatient joint replacements at ASCs cost 40% less than hospital-based surgery: 3 study details Apple’s groundbreaking heart study signals a new era of medicine, and doctors are debating the results What’s to keep Amazon from competing... READ MORE

NATIONAL Judy Faulkner asked the press to dig into physician burnout and EHR satisfaction. So we did Nearly all hospital leaders say supply chain optimization improves margins, survey shows Amazon to close pop-ups as its healthcare venture site debuts Report: FDA hiding millions of adverse event reports from docs, public Critical condition: The crisis... READ MORE

NATIONAL How 6 major health systems and hospitals hope to boost housing Medicare trims payments to 800 hospitals, citing patient safety incidents CHIME to Congress: HIPAA isn’t enough to ensure cybersecurity Breast cancer screening bundled payment model incentivizes cost savings Value-based care shift among highlights of MGMA 19 financial conference Freestanding EDs charge up... READ MORE

Location, location, location – this will be the focus of a Medicare hospital claims processing requirement. Starting in April 2019, CMS will activate billing edits that will Return to Provider (“RTP”) any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare enrolled location identified in Provider... READ MORE

During a speech on March 4, 2019, Secretary of Health and Human Services Alex Azar announced that the Trump administration plans to overhaul the Medicare payment system for certain dialysis services provided to patients with end-stage renal disease. The overhaul, as envisioned, would incentivize moving the place of treatment from outpatient clinics to home... READ MORE

Over the years, there have been a number of federal cases involving allegations that health care providers used improper real estate arrangements to induce referrals. Recently, two real estate-related cases have made headlines. Hospitals should pay careful consideration to the following two cases. Serial Whistleblower Seeks to Overturn Ruling Involving Alleged Cash-Flow Subsidies under... READ MORE

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE