The nation’s largest city saw its cases soar past the 1,000 mark this week.
I wish that I was writing under better circumstances, but these are difficult times in New York, and across the United States.
As of Tuesday, New York State had more patients identified with COVID-19 than any other state in the U.S. This is not a distinction that anyone here had hoped for.
It was announced Tuesday that 1,374 cases of COVID-19 had been confirmed, including 644 in New York City. There are three patients who have died in New York so far. These numbers are being updated as we speak.
New York Governor Andrew Cuomo has watched world events closely, particularly in Italy, Spain, and China. He has called on the federal government to mobilize the U.S. Army Corps of Engineers to convert existing state-owned facilities, like State University of New York dormitories, into medical facilities. It is true that there are approximately 3,000 ICU beds at hospitals in the state; however, these beds are already 80 percent filled. That means there are only 600 available ICU beds in New York State at any given time.
If New York’s clinical capacity is not increased immediately, Cuomo predicts that New York’s hospitals “will soon be overwhelmed by an oncoming wave of coronavirus patients.”
Faced with this dire reality, Governor Cuomo last week issued an Executive Order (effective through April 11) that suspends certain laws and regulations to allow for expansion of services and temporary facilities for hospitals and other health and human service providers:
The New York Department of Financial Services announced the removal of barriers to testing and treatment for COVID-19 in a letter issued March 3.
The letter states that insurers should not use preauthorization requirements as a barrier to accessing COVID-19 treatment, and should be prepared to expedite utilization review and appeal processes for services related to COVID-19.
Hospitals are awaiting the release of emergency Department of Financial Services regulations prohibiting health insurers from imposing cost-sharing on in-network provider office visits, urgent care center visits, or emergency room visits when the purpose of the visit is testing for COVID-19. The Hospital Association of New York State is advocating that cost-sharing prohibitions include all copays, deductibles, and other out-of-pocket costs.
In states like New York, where the governor has declared an emergency, Medicare Advantage plans must cover services by out-of-network providers at the in-network cost-sharing rate, and also waive gatekeeper referral requirements.
New York’s Medicaid program will cover services for physicians, clinics, and emergency visits without copays for patients when the purpose of the visit is testing for COVID-19. New York State Medicaid will add HCPCS codes as they become available.
Outside of the state healthcare systems, other serious steps are being taken to curb the spread of the virus. All schools in New York City and many surrounding counties have been closed. Any large gathering or event for which attendance is anticipated to be in excess of 50 is prohibited or postponed. Monday morning, the U.S. Centers for Disease Control and Prevention (CDC) issued similar guidance.
Across the Hudson River in New Jersey,
The New Jersey Hospital Association has announced a restricted visitors’ policy for all New Jersey hospitals, nursing homes, and other post-acute care facilities.
No hospital visitors will be allowed until further notice, with limited exceptions, including:
Importantly, even visitors who meet these exceptions must be screened for symptoms before being allowed to visit.
In addition, hospitals and other healthcare providers in coronavirus hot spots are being forced to fast-track work-from-home strategies.
These are unique times that we are dealing with. Updates on the virus, its spread, and its impact seem to come faster than we can digest them. We will look for specifics to flesh out the general policies and regulations that have been announced, and we will have to keep up with local state and national events as best as we can until new, effective treatments and a vaccine are developed.
I do not usually report on what other media are reporting (with the exception of Nina Youngstrom’s reports on Medicare compliance!), but John Oliver’s story
In the Medicare fee-for-service world, “prepayment review” (also sometimes called “prepayment medical review” or “pre-claim review,” depending on the context) means that a claim is
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
