Articles
View Versalus Health’s recent articles and interviews.
Addressing the Inefficiencies in Clinical Revenue Cycle
Article originally published in Healthcare Business Review April 2023 Addressing the Inefficiencies in Clinical Revenue Cycle Competent revenue cycle management is integral to running a successful healthcare organization. It streamlines the billing and revenue...
The Perils of Being ‘Too Big to Fail’ for Healthcare Providers
The Perils of Being 'Too Big to Fail' for Healthcare Providers Originally published on RAC Monitor December 14, 2022 by Dr. Jerilyn Morrisssey Last quarter UnitedHealth Group (UHG) beat Wall Street expectations with revenue of $80.9 billion, up 12% year over year....
Report on Medicare Compliance: PAs: Admission Screening Tools, LOC Reviews Are Unnecessary
Report on Medicare Compliance
Price transparency, elimination of inpatient-only list take centerstage at January Quarterly Call
Revenue Integrity Insider Price transparency, elimination of inpatient-only list take centerstage at January Quarterly Call Wednesday, February 3, 2021 by Kevin Duffy NAHRI’s January 26 Quarterly Call featured important association updates, as well as presentations on...
Fighting the Rising tide of Claim Denials: A Physician Speaks Out (from RACmonior)
Listen to Monitor Monday for November 29, 2021. Dr. Jerilyn P. Morrissey has the lead story for this episode of Monitor Monday on how Medicare Advantage plans appear to be bulling providers denying claims and fabricating rules for denials. Dr. Morrissey’s section starts on minute 24:50. Look for the episode titled: Resisting Medicare Advantage Bullies.
Hospital Survival in a Frictionless Utopia Part III
Hospital Survival in a Frictionless Utopia Part III By Jerilyn Morrissey, MDPublished: March 29, 2022 Originally published on RACmonitor: https://racmonitor.medlearn.com/hospital-survival-in-a-frictionless-utopia-part-iii/ Hospitals need a cross-functional approach...
Is a Frictionless Relationship Between Payers and Providers a Utopian Dream? Part II
Is a Frictionless Relationship Between Payers and Providers a Utopian Dream? Part II By Jerilyn Morrissey, MD March 23, 2022 Originally published on RACmonitor: https://racmonitor.medlearn.com/is-a-frictionless-relationship-between-payers-and-providers-a-utopia... The...
Is a Frictionless Relationship Between Payers and Providers a Utopian Dream?
Is a Frictionless Relationship Between Payers and Providers a Utopian Dream? By Jerilyn Morrissey, MD Published: March 9, 2022 Orignially published on...
Medicare Advantage Plans and the Two-Midnight Rule
Versalus’ Dr. Jerilyn P. Morrissey discusses the Medicare Advantage Plans and the Two-Midnight Rule
Discovery of Nearly $3 Billion in Medicare and Medicaid Errors from RACmonitor
Monitor Mondays - Past Episodes - RACmonitor
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CMS Gives Clear Indication the Public Health Emergency Will Soon End. What does this mean for you?
By Angela Sorbelli, J.D., LL.M, MBA, CHC On April 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release detailing the beginning of the phase-out activity for the temporary emergency waivers that have been in effect since the beginning...
“Looking into My Crystal Ball” – The End is Near…for the 1135 Waivers To Expire
he United States has been in a state of Public Health Emergency (PHE) due to the coronavirus pandemic since January 2020. Section 319 of the Public Health Services (PHS) Act grants the authority to declare and re-evaluate the need for the PHE to the Secretary of Health and Human Services, who reviews the emergency declaration every 90-days and determines whether an extension is warranted.
2022 Medicare Sequestration Considerations
Overview In a late 2021 legislative session, Congressional activity resulted in a little bit of breathing room for hospitals after the New Year. In a bipartisan vote by Senate late last week, legislation was passed that mitigates nearly 10% Medicare reimbursement cuts...
CMS Doubles Down on Their Expectation for Price Transparency
On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (CMS-1753-FC), finalizing this year’s Medicare payment rates for hospital outpatient and ASC as well including regulatory guidance regarding several high profile policies for hospitals providing outpatient services. CMS evaluated industry feedback to the proposed modifications, including halting the elimination of the Inpatient Only list (IPO), broadening the impact of the Hospital Price Transparency Rule, and other updates.
COVID-19 Provider Relief Fund Updates
Additional Funds, Delay in Reporting Requirements, and Audits The Provider Relief Fund (PRF) was established when Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support American families, workers, and healthcare providers in the...
Don’t Use Denial Rate to Measure a Payer’s Performance
By Jerilyn Morrissey, MD Regardless of who your team reports to on the organization chart, there is no getting around the fact that Utilization Management (UM) is part of the clinical revenue cycle of your organization. Embracing that concept may challenge your...
What Your Denial Rate Is Not Telling You
Let’s talk about denials, a frequent and often unpleasant topic in Utilization Management (UM). One of the core beliefs of most UM teams is that denials are bad, and most of UM teams’ efforts are spent trying to prevent or reduce denials. You may have even purchased...
Will Medicare Beneficiaries pay more for a procedure no longer on the Inpatient-Only List?
There is still a lot of confusion regarding the impact on Medicare beneficiaries from eliminating the Inpatient-Only List. As recent as last week, an article from The Washington Post titled New cost-cutting Medicare rule may add costs to patients, discussed how this...
Do More Denials Mean More Revenue?
By Joseph Zebrowitz, MD Denials Are Bad…Maybe Not One of the central tenets of utilization management is that “denials are bad.” Our hospitals have developed a myriad of Key Performance Indicators (KPIs) that reflect this: we track denial rate and total number of...