Category: Revenue Cycle Management

Dos And Don’ts For Managing Inpatient-to-observation Status Downgrades

Dos And Don’ts For Managing Inpatient-to-observation Status Downgrades

  In the newest episode of the HealthLeaders Revenue Cycle Podcast, Charlie Brown, MBA, a former hospital executive and vice president of revenue cycle at a consulting firm, provides actionable steps for mitigating status downgrades and dealing with them effectively to ensure that organizations receive the full reimbursement for the services they provided. In his […]
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Hospital Pros and Cons of the CY 2022 OPPS Proposed Rule

Hospital Pros and Cons of the CY 2022 OPPS Proposed Rule

Hospital groups are digesting the 863-page CY 2022 OPPS proposed rule, but many are already commenting on new hospital price transparency penalties and other policies. The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other policies. The […]
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Despite Drop in Healthcare Mergers and Acquisitions, Revenue Rises

Despite Drop in Healthcare Mergers and Acquisitions, Revenue Rises

Analysis from Kaufman Hall reveals a historically low number of healthcare mergers and acquisitions in Q2, but revenue continues to rise. Healthcare merger and acquisition (M&A) activity was minimal in Q2, but total transacted revenue rose as health systems focused on acquiring smaller hospitals and strengthening regional partnerships, according to Kaufman Hall’s quarterly M&A report. […]
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4 Reasons Why UnitedHealthcare’s Attempt To ‘Monday Morning Quarterback ED Claims Is ‘Bad Policy’

4 Reasons Why UnitedHealthcare’s Attempt To ‘Monday Morning Quarterback ED Claims Is ‘Bad Policy’

“It really undermines what the physicians are doing at the point of care, and it’s bad policy,” says Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage. UnitedHealthcare’s attempt to “Monday morning quarterback” emergency room visits by retroactively denying emergency claims is not only likely a violation of the prudent layperson standard, […]
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Pros, Cons of Non-Emergency Medical Transportation Benefits

Pros, Cons of Non-Emergency Medical Transportation Benefits

MACPAC’s June 2021 report to Congress included findings about non-emergency medical transportation benefits in Medicaid programs that could prove useful for benefits design. A small fraction of the Medicaid population utilizes non-emergency medical transportation (NEMT) benefits, but for that community of beneficiaries NEMT programs can be indispensable, a MACPAC report recently found. It has been […]
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Emergency physicians call United healthcare’s ED denial Policy ‘Dangerous’

Emergency physicians call United healthcare’s ED denial Policy ‘Dangerous’

The American College of Emergency Physicians said that it “firmly believes that the new policy is in direct violation of the federal Prudent Layperson Standard.” Calling it a “dangerous decision” and a “scare tactic,” the American College of Emergency Physicians (ACEP) is condemning UnitedHealthcare’s recent announcement to retroactively deny emergency care claims. “ACEP firmly believes […]
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