Hospitals and physicians are increasingly working to form strategic alliances that can help both parties survive the increasingly complex health care environment. There are many goals for such alliances, but for every alliance that works out well, there are at least as many that come to grief. Here are some of the common issues that—when addressed properly—can help pave the way for success
Medicare released a proposed rule in the Federal Register , “Medicare Program; Part B Inpatient Billing in Hospitals,” in March 2013. That proposed rule, in combination with the ruling for Part A to B denial rebilling—which was effective immediately on publication—is intended to get a handle on a huge area of heartburn for hospitals.
The results of recent recovery audit contractor (RAC) automated reviews of hospital services were outlined in the January 2013 Medicare Quarterly Provider Compliance Newsletter, Volume 3, Issue 2 . Among the hot topics discussed was a significant issue for physician providers: the RACs identified that inappropriate current procedural terminology (CPT) codes were being assigned for related professional evaluation and management (E/M) services “rendered in swing bed facilities (with nursing facility levels of care)” in the same episode of care as an acute inpatient stay, when the patient was not “on a leave of absence from the hospital.” Specifically, inpatient hospital CPT codes, i.e
On June 22, 2012, the IRS issued proposed regulations regarding several additional requirements enacted by the Patient Protection & Affordable Care Act applicable to tax-exempt hospitals.
On July 29, 2011, the Centers for Medicare & Medicaid Services (CMS) issued its final rule for federal fiscal year 2012 to update payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs). The following are highlights of the final rule