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MiraMed’s eAlerts are distributed via email every Wednesday, and contains the latest industry information regarding business process outsourcing solutions, helpful coding news, or any number of relevant topics in the fast-paced, ever-evolving world of healthcare. To subscribe, simply complete the form below. Below the subscription form, you will find the archived eAlerts available.

November 13, 2013

In our October 2 alert, we discussed the Centers for Medicare and Medicaid Services’ (CMS) rule regarding the new “two-midnight” rule and hospital inpatient admissions.  This rule, finalized by the 2014 Inpatient Prospective Payment System, states that an inpatient admission is presumed reasonable and necessary, and payable under Medicare Part A, if the inpatient admission spans at least two midnights (Final Rule).  Inpatient hospital admissions spanning less than two midnights are presumed inappropriate for payment under Medicare Part A.  Last week, CMS issued additional guidance in two documents, Reviewing Hospital Claims for Patient Status and Selecting Hospital Claims for Patient Status Reviews, for Medicare Administrative Contractors (MACs) regarding how they are to select and review inpatient hospital admissions claims for payment purposes under Medicare Part A. CMS also issued a frequently asked questions document, Questions and Answers Relating to Patient Status Reviews, that assists in answering questions related to the new rule and patient status reviews. (Proposed Rule).

Read more: CMS Releases Additional Guidance Regarding Two Midnight Rule

November 6, 2013

Last week, the Healthcare Financial Management Association (HFMA) released its final Patient Financial Communications Best Practices (Practices).  According to HFMA’s press release on the Practices, it “address[es] the industrywide [sic] call for better communications between patients and healthcare organizations…[and] improv[es] and standardiz[es] how healthcare organizations communicate with patients about their financial responsibilities.”  The intent of the Practices is to set forth certain elements that would be incorporated into an organization’s compliance program or compliance plan.

Read more: Final Best Practices in Patient Financial Communications Released

October 23, 2013

The Affordable Care Act (ACA) promises to expand care to millions of Americans, but will it happen?  One factor, the medical necessity of care, will continue to serve as the key means for determining which health care services get paid or denied.

Read more: Medical Necessity and the Affordable Care Act

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