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Versalus Health Blog

Aligning Payor-Provider UR Practices – Proceed with Caution!

By Joseph R. Zebrowitz, MD Over the last few years, there has been a trend toward automating the medical necessity UR screening process using software to extract clinical data and either apply commercial criteria or create an acuity score.  As I have strolled across trade show floors, I see company after company touting what appears… Continue reading

Vulnerabilities Remain Under Medicare’s 2-Midnight Policy Copy

In 2016, the Office of the Inspector General (OIG) published a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Policy”, summarizing the first findings of hospital billing patterns since the implementation of the Two-Midnight Rule. The results surprised many who believed that a slight adjustment to existing protocols would accommodate the Rule changes. Despite the findings, many hospitals have not addressed the guidance.

You Can’t Get the Right Answer if You Don’t Ask the Right Question

In 2013, the Centers for Medicare and Medicaid Services (CMS) finalized the “Two-Midnight” Rule addressing when beneficiary hospitalizations are appropriate for inpatient payment under Medicare Part A. CMS adopted the “Two-Midnight” Rule to simplify the beneficiary admission decision establishing a new standard for selecting whether a beneficiary should be considered inpatient or outpatient. CMS stated… Continue reading

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