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Welcome to the weekend and thanks for checking in. 

We’re bringing you the news from the past week as well as providing you with a look at the week ahead. And, looking ahead we have a preview of tomorrow’s edition of Monitor Mondays. 


On Wednesday, the Centers for Medicare & Medicaid Services (CMS) announced the long-awaited and highly anticipated MACRA Proposed Rule that would replace the meaningful use program under the HITECH Act for physicians participating in the Medicare Program under the Medicare Access and CHIP Reauthorization Act.

Also on Wednesday, Monitor Monday correspondent Bob Soltis, a former ALJ, posted a comment about the Center for Medicare Advocacy criticism of the CMS proposed rule that will require hospitals to provide a standard Medicare Outpatient Observation Notice (MOON) that, unlike other notices of non-coverage, does not require the provider to say why Medicare won’t pay. Soltis said the email alert from advocacy group described the rule as the product of an “office of mean-spirited policy.” Soltis went on to write that the ‘Center for Mean-Spirited’ policy could be the new moniker for CMS.

Soltis also came up with this little ditty: 

Hey meddle diddle
CMS with the law did fiddle
and made a form implementing it called MOON
Beleaguered beneficiaries
will probably swoon.


RACmonitor eNews 

Here are highlights of several of the articles you’ll be reading next Thursday in the RACmonitor e-News.

The One-Midnight Rule

Steven J. Meyerson, MD, responds to the Centers for Medicare and Medicaid Services (CMS) rejection of a proposal for a “one-midnight rule” for Medicare admissions, which he authored. Meyerson writes that the American College of Physician Advisors’ (ACPA) and the American Case Managers Association (ACMA) both endorsed and submitted this idea during the comment period for the 2016 Outpatient Prospective Payment System (OPPS) proposed rule (CMS-1633-P).

MACRA Proposed Final Rule: More Questions than Answers?

RACmonitor rural health correspondent Janelle Ali-Dinar, PhD, will report on proposed final rule for Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) released last Wednesday.

According to Ali-Dinar, one of the biggest highlights revealed is that MACRA removes the sustainable growth rate formula, which cut Medicare payments for services, and replaced it with a .5 percent year-over-year increase in the physician fee schedule.

When the Government Wants to Skype with You

Also in next Thursday’s edition, healthcare attorney David Glaser offers strong advice to those seemingly innocent invitations to meet with a government agent. This one came as a Skype meeting. 

When the Short-Stay Inpatient Rate is Zero 

The revised exceptions policy found in the 2016 Outpatient Prospective Payment System Final Rule (CMS-1633-F), which became effective January 1, 2016, may change how providers determine patient status, writes Ralph Wuebker, MD, MBA, chief medical officer at Executive Health Resources. He’ll report that hospitals may need to re-evaluate their clinical documentation improvement programs.    

Upcoming Webcasts

You are your staff are certain to find value in the following upcoming webcasts being produced by RACmonitor. 

Creating Healthier Rural Communities

Thursday, May 12, 2016
1:30-2:30 p.m. ET 

Rural healthcare authority Janelle Ali-Dinar, PhD, is producing a webcast for RACmonitor readers on the state of rural. The presentation will address rural precision medicine, advanced diagnostics, and population health methods/services of treatment to bridge the gap of care for the most critical needs of rural populations including chronic disease management, opioid abuse, and medication management and premature deaths. Register here.

How to Win Against Auditors Who Use Dirty Tricks Against You

Wednesday, May 25, 2016
1:30-2:30 p.m. ET

Not all contract auditors are bad.  But some are, and they know how to manipulate hospital data to make the facility look like it cheated the federal government. Based on an auditor’s gross manipulation of a hospital’s claims data, a facility could end up owing millions of dollars based on an extrapolation from only 30 claims. In his upcoming webcast, New York attorney Edward Roche, PhD, JD, will reveal how facilities can learn the secrets behind the devious tricks used by unscrupulous contract auditors. Register here.

In Production

Patient Rights

Ronald Hirsch, MD, FACP, CHCQM
Thursday, June 9, 2016
1:30 p.m. ET 

The controversy over observation led Congress to pass the NOTICE Act requiring written notification to observation patients. 


Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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