In general, physician-owned distributorships (PODs) are companies with physician owners or investors that sell implantable medical devices to hospitals and healthcare facilities. The revenue generated by PODs typically derives from orders by the PODs’ physician owners, who also use the implantable medical devices for procedures on their own patients at hospitals or healthcare facilities. Although there are a variety of ways in which POD arrangements are structured, they generally offer physician …Read more
The relationship between healthcare payers and providers is often complicated, tumultuous, and adversarial. The drastic increase in Recovery Auditor (RAC) and other third-party payer audits over the past several years has exacerbated this issue. During a recent provider-payer panel session at the HealthPort’s annual Health Information (HIM) Education Summit, the presence of a deep language barrier dividing these entities became clear. Plan representatives mentioned that some providers understand their requests, but …Read more
As we mark the first anniversary of the two-midnight rule, more private payers are opting to implement it – or some principle that is at least based on it. I received an email from one hospital asking: “One of our Medicare Advantage plans said that they plan to ‘use the two-midnight rule’ and (that) they will also continue to use ‘evidence-based guidelines.’ My question is ‘can they do it?’” That is an …Read more
On Sept. 30, the Centers for Medicare & Medicaid Services (CMS) held a hospital open-door forum in which the first item on the agenda was the 68-percent settlement offer on pending appeals. After a review of the basics of the offer, CMS representatives entertained questions. One provider inquired about a common scenario: an admission having been denied by an auditor, the...Read more
In its continued effort to force transparency on everyone but itself, the government, through the Centers for Medicare & Medicaid Services (CMS), has released another data dump that is supposed to shed light on the financial relationships between vendors and healthcare providers. In reality, what it does shed is just more noise and confusion on an already noisy and confusing issue....Read more
It is not enough to merely audit the codes billed by the provider of healthcare services. You also must review the modifiers appended to the services to validate that they were used in an appropriate manner. The modifiers must be validated to verify that their use is corroborated within the medical documentation and medical necessity of the medical record. Coders, billers,...Read more
Hospital life changed forever on Tuesday, October 1, 2013 with the Inpatient Prospective Payment that promulgated the controversial "two-midnight rule." As hospitals approach the anniversary of the two-midnight rule, what lessons can be learned? What issues surfaced this year with the implementation of the two-midnight rule in health systems with multiple electronic health records (EHR) systems in multiple settings?
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