Government Affairs Committee – Member ArticlesUnauthorized Plan Switching and Enrollment in ACA Health Plans The Narrow Network Conundrum: Admit or Transfer and the No Surprises Act” What’s in a Name? Health Plan Physicians Deny Care Cloaked by Anonymity Physician Advisors: Advocating for Medicaid Reform at the State Level Satisfaction Guaranteed: Turn Frustration into Action with Medicare’s Complaint Process MA Plans and 4201-F The Critical Role of Prior Authorizations in Infusion Therapy Hospital to Health Plan and Back Again – A Physician Advisor’s Perspective MA and the Two-Midnight Rule: What’s Wrong with this Picture? 2024 Deductibles, Coinsurances and Copayments – Know the Numbers LTACHs and MA Plans – Understanding Why The Rules Are Different CMS Proposes New Appeal Process – Complexity is High, but Impact is Low The Evolving Medicare Advantage Plan Landscape: Hospital Preparedness for CMS-4201-F Adversaries and Partners – Can a Payer be Both? Preoperative Testing: Dogma or Dilemma Saving Lives by Discharging Patients – and a QIO Skirting the Rules United Healthcare’s Medicare Advantage and the Two-Midnight Rule NCDs, LCDs, Discharge Planning, and Home Care – All in One Article Time to Treat Your Family and Friends CMS Says Post-Acute Care Choice Only Goes So Far More DRG Reductions Coming? Opening an Artery Creates an Opening for Auditors The Crux of Criteria: Adhering to Standards of Care Transfers and Medicare Payment – Who Knew it Could Be So Complex? Hospice Conundrums (Part 1): Demystifying GIP, Ensuring Appropriate Use, Documentation, and Payment I Want a SNF Please… Provider Access to CMS Appeals in Medicare Advantage Medicare Advantage and the Two-Midnight Rule CMS Tells Livanta to Reassess Short-Stay Memo Discrimination Against the Disabled? Not on CMS’s Watch Why Are Patient Appeals More Common Than Expected? Medicare Two-Midnight Rule Exceptions (Short Stays) $3.50 or $10,800,000? How Much Does a Service Actually Cost? CMS Sends Up Warning Flare on Discharge Planning Livanta Memo Highlight of Healthcare News Week Important: Livanta Confirms Stance on One Day Inpatient Admissions Malnutrition and Inpatient Admission – Two Updates MOON Review a Week after the New Moon – on Monday Refusing to Tolerate Patient Violence Plenty of Healthcare News to Cover as Summer Heats Up The Right Observation Rate – I Have the Numbers, Sort of… Readmissions: Understanding the Complex Finances and the Hidden Nuances Case Managers Don’t Demand Discharges – And They Also Face Moral Distress While Working to Solve the Problem All Healed Up with Nowhere to Go Understanding the PEPPER: “My Patients are Sicker than Everyone Else’s Patients” Inpatient Rehabilitation Admissions Go Under the Microscope…in One State Breaking News: Medicare Advantage Must Follow Two-Midnight Rule Providers - Now is the Time to Change How We Document! Getting on Board - the Problem with ED Boarding An Observation about Observation Rates (and Other Notes) Status, Ethics, and Decision-Making Capacity – All in One Case QIO Short Stay Audits and the CMS IPO List Imagine Developing an Effective IP Hip and Knee Joint Program Condition Code 44 and its Compliant Execution Yes, You Can Admit Psychiatric Cases as Inpatients Medicare Advantage Star Ratings... What Are They? Why Should We Care? What Can We Do About Them? Cancelled Surgery – Change the Status? Insist on Covered or Not Covered Inpatient Only Procedures (IOP) Now Procedures of Interest (POI) in 2021 Court: Patients Must Be Able to Appeal Status Change from Inpatient to Observation |