Lawsuit filed against UnitedHealth for underpayment of telehealth services
Editor's Note A female patient in Chicago, Illinois, filed a lawsuit on July 7 against the multinational UnitedHealth Group for alleged underpayment of telehealth services, Becker’s Payer Issues July 8 reports. The lawsuit claims that the woman’s insurance plan covers telehealth services, including pay benefits for-out-network services. After receiving out-of-network…
CMS physician fee schedule proposes 4.43% cut in 2023
Editor's Note The Centers for Medicare & Medicaid Services (CMS) released its Medicare physician fee schedule proposed rule for 2023, “which suggests further cuts to physician pay while inflation and the cost of running an independent practice continue to rise,” Becker’s ASC Review July 8 reports. The proposed rule would…
CMS updates ASC guidance, revisions for surveyors
Editor's Note The Centers for Medicare & Medicaid Services (CMS) has recently updated its State Operations Manual (SOM) Appendix L—Guidance for Surveyors: Ambulatory Surgical Centers (ASCs), making conforming revisions to the regulatory tags and interpretive guidelines, as well as clarifications and technical corrections to other guidance areas including medical history…
Most hospitals not providing price information for TJAs as required by CMS
Editor's Note This study from the Cleveland Clinic finds that less than one-third of US hospitals were fully compliant in 2021 with the transparency in pricing for total joint arthroplasty (TJA) rule mandated by the Centers for Medicare and Medicaid Services (CMS). Of 400 hospitals analyzed between December 1 and…
CMS citation trends show infection control in top 10 cited areas
Editor's Note According to the Centers for Medicare & Medicaid Services (CMS) Quality, Certification, and Oversight Reports (QCOR) page, which gives the public access to citation frequency reports, infection control was a top area of focus for CMS surveyors in 2021, the Ambulatory Surgery Center Association journal ASC Focus June…
The Joint Commission: Accelerate PI Dashboard Reports available
Editor's Note The Joint Commission on May 25 announced that refreshed Accelerate PI Dashboard Reports are available for accredited hospitals and critical access hospitals to provide updated performance measurement data on a select subset of quality measures. The Interim ORYX reports contain data through the second quarter of 2021, and…
Association of COVID-19 with disparities in access to major surgery
Editor's Note This study, led by researchers from the University of Rochester (NY) School of Medicine, finds that the early response to the COVID-19 pandemic did not increase disparities in access to major surgical procedures. Of 3,470,905 adults hospitalized for major surgical procedures at 719 facilities between January 1, 2018,…
Joint Commission approves COVID-19 vaccination standard for HCWs
Editor's Note In response to the Centers for Medicare & Medicaid Services (CMS) interim final rule regarding COVID-19 vaccinations for healthcare workers (HCWs), The Joint Commission has approved a new Infection Prevention and Control (IC) Standard IC.02.04.02 and new elements of performance, the regulator announced on April 27. The new…
CMS releases FY 2023 hospital IPPS proposed rule
Editor's Note The Centers for Medicare and Medicaid Services (CMS), on April 18, released the FY 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) proposed rule. The rule would increase payment rates by a net 3.2% for acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and…
CJR program reduced some racial differences in outcomes
Editor's Note This study from the Icahn School of Medicine at Mount Sinai, New York City, finds that Medicare’s Comprehensive Care for Joint Replacement (CJR) program led to a reduction of racial differences in hospital readmission rates for patients having hip or knee replacement surgery. The retrospective cohort study included…
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