Thought Leadership
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For discharges occurring on and after April 1, 2022, coders will have access to new ICD-10-CM and ICD-10-PCS codes. April 1st will also introduce the new Medicare Code Editor (MCE) edit 20 – Unspecified Code Edit. The 2022 IPPS Final Rule stated there would now be coding updates in both October and April. The goal […]
Healthcare organizations need to pay attention to the amount of time it takes patients to get insurance verification and authorization completed. If the process takes too long, patients will seek treatment at other facilities even if they were referred to your organization. Insurance Verification and Authorization Benchmark Notwithstanding patient choice, outpatient therapy providers should be […]
On January 14, 2022, Centers for Medicare & Medicaid Services updated the Technical Users’ Guide for the Care Compare Nursing Home Five-Star Quality Rating System. While this information will be publicly reported starting in January, it will not be used in the Five-Star Quality Rating System until July 2022. Here is what you need to […]
It’s the second week of January and the Provider Relief Fund reporting portal is open for Period 2 reporting. The portal will remain open until March 31, 2022 and is for reporting on payments received between July 1, 2020 and December 31, 2020. The layout and design of the portal is unchanged from Period 1, […]
Do you know that CMS is making significant changes to split/share and critical care services in 2022? Are your providers aware of the changes? Are they prepared to modify the documentation of these services? Are your coders prepared to report the required modifier? On November 2, 2021, CMS released the 2022 Physician Fee Schedule Final […]
How would you like to reduce medical necessity denials in your outpatient therapy services? One way to do that is to ensure your therapists are capturing the impairment diagnoses in the plan of care. What is Impairment Diagnoses? Chapter 15 of the Medicare Benefit Policy Manual states: “a diagnosis (where allowed by state and local law) […]
President Biden’s administration recently announced its Path Out of the Pandemic action plan which included specific guidance around a COVID-19 vaccine mandate. The action plan calls for employers with 100 or more employees to require employees to be vaccinated or submit to weekly tests, as well as requiring vaccinations for federal employees, contractors, and hospitals […]
Last week there were two new rules issued by the Biden administration regarding vaccine mandates. The Center for Medicare and Medicaid Services (CMS) released an interim final rule (IFR), along with the Emergency Temporary Standards released by the Occupational Safety and Health Administration (OSHA). Providers Involved: Ambulatory Surgical Centers Hospice Agencies Psychiatric Resident Treatment Facilities […]
by Joseph Evenson, Staff Accountant In the business valuation world, due diligence is crucial now more than ever. The “same as last year” mentality is no longer acceptable until we have a few years of stability under our belts. COVID-19 has been, and continues to be, a unique challenge for businesses and business owners. Some […]
By John Britt, Senior Manager Outpatient therapy is a recurring service; for example, a routine plan of care is often 12 visits over 30 days. With rising co-pays and deductibles, patients are increasingly choosing less care, meaning less visits, than the therapists are recommending in the plan of care because of financial constraints. Your department […]
Pursuant to KRS 205.640 and managed care contracts, Kentucky Medicaid Managed Care Organizations (MCOs) are required to provide a Paid Claims Listings (PCLs) to all in-state hospitals. The department and each Medicaid Managed Care Organization shall supply a Paid Claims Listing (PCL) to each hospital within ninety (90) days of the last day of the […]
By Brandon Nowling, CPA, CVA, Senior Accountant COVID-19 has created much uncertainty for business owners who are considering buying or selling a business during these troubling economic times. Many owners who are considering selling are asking themselves, “What will the lasting impact be on my business? Will the decline in revenue during 2020 impact my […]
The Volume Decrease Adjustment (VDA) is a lump sum payment available to Sole Community Hospitals (SCH) or Medicare Dependent Hospitals (MDH) who have experienced more than a 5% decrease in total discharges of inpatients as compared to the immediately preceding cost reporting period. The decrease in total discharges must be caused by circumstances that are […]
When looking at your Outpatient Physical and Occupational Therapy departments, have you noticed a decrease in the volume of outpatient services? At Blue & Co. we often find that many hospitals and hospital systems have viable candidates for outpatient therapy services but are being seen by another healthcare organization due to a lack of a […]
Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (CMS-1746-F) was released on July 29, 2021 by the Center for Medicare and Medicaid Services (CMS). Here is what you need to know about the Final Rule for Skilled Nursing Facilities. Thanks to the stakeholder comments received by the CMS they […]
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In the past several years, hospitals have continued to feel the impact on revenue from Clinical Validation Denials (CVD). The need for a robust CDI team to capture support for clinical indicators while the patient is still in house is more imperative than ever. The other overwhelming piece for revenue cycle teams to manage is […]
Ensuring the long-term financial viability of a health system requires constant attention to the operating statement. This involves assessing the current state of your healthcare organization and critically comparing the current condition to industry and/or internal benchmark standards. Ultimately, this assessment assists management implement an ongoing margin improvement process to increase the likelihood of achieving […]
For hospitals, managing the length of stay is not a new concern. What has changed, however, for many hospitals is the level of attention and focus on it. At the height of Covid-19, many hospitals were merely in “survival mode” and were doing everything they could to meet the patient’s needs. Born out of necessity, […]
Hospital systems and healthcare organizations that employ physicians have struggled to promote patient access. Access issues may result from misaligned compensation and organizational goals, practice operations process or capacity issues as well as a host of other reasons. Compensating physicians on purely a productivity basis may be helpful from a billing and monitoring perspective, but […]
Rising interest rates and historic inflation are impacting hospital purchasing decisions. Using capital efficiency concepts in making hospital purchasing plans is as important as ever. What is Capital Efficiency? Capital efficiency refers to how effectively a hospital deploys its resources to generate returns. In the context of fixed assets and software purchases, capital efficiency involves […]
Conducting a feasibility study is an essential step in determining the viability of implementing a new healthcare program, service, or project. These studies help healthcare organizations assess the potential risks and benefits of their proposed projects before investing significant time, money, and resources into planning for them. Feasibility Studies 101 Feasibility studies typically involve an […]