Physician, Hospital UR Expert, husband, father, road cyclist. Posts, RTs and links absolutely personal opinion and not endorsement by my employer.
Jan 25, 2021 • 14 tweets • 6 min read
Medicare Regulation #Tweetorial time!
Determining status for Medicare patient undergoing elective surgery.
CMS is eliminating the inpatient only list over the next 3 years and started 1-1-21 with all orthopedic and most spine surgeries. So how do you determine status? 1/
First, note this is Medicare FFS only. Every other payer, incl Medicare Advantage, gets to make their own rules.
Also, status affects hospital payment and not surgeon payment. But without money, hospital cannot buy new toys for surgeons to use in OR. 2/
Jul 30, 2019 • 14 tweets • 3 min read
While many concentrate on the Physician Fee Schedule Rule, I found some nuggets in the OPPS Rule. Here is a summary thread @BetsyNicoletti@BillFoxMD@SEricksonACP@YoungstromNina@AmerCollPhyAdv
Price transparency moves further ahead. Hospitals will need to post all charges in a standardized way; no more Excels with only internal codes and indecipherable abbreviations
Jun 2, 2018 • 20 tweets • 9 min read
Since @RosenthalHealth brought up the "insist on inpatient" myth again, I thought it was time for a #tweetorial on patient financial obligations. Let me explain it properly.
First, am I qualified to talk about this? Yep, I am the co-author of The Hospital Guide to Contemporary Utilization Review amazon.com/Hospital-Guide… THe second edition will be published soon. I lecture around the country on @CMSGov regulations.
