A number of COVID-related stories emerged this week that are worth following up on.
First, earlier this month, the U.S. Department of Health and Human Services (HHS) reminded providers that if they received COVID relief funding, they are not to balance-bill patients who were being treated for COVID.
Last week, HHS announced that they will be conducting a nationwide audit of hospitals that received COVID relief, to make sure of this. As part of the audit, the HHS Office of Inspector General (OIG) says it will look at how bills were calculated, and ask for documents that show a hospital is in compliance.
Also last week, the Government Accountability Office (GAO) released a report suggesting that HHS was bungling the management of this pandemic, and was certainly not ready for another one. The GAO placed HHS on a high-risk list, meant for government agencies that are at risk for fraud or mismanagement.
Specifically, the GAO said that HHS had not established clear roles and responsibilities across federal, state, and tribal partners in managing the pandemic.
Some other healthcare news coming out of Washington, D.C. include the following:
HHS has put out a request for input (RFI) on electronic prior authorization standards. The RFI is focused on how prior authorization systems can be better designed to reduce administrative burden.
The Trusted Exchange Framework and Common Agreement (TEFCA) was also finalized this month. TEFCA, mandated by the 21st Century Cures Act in 2016, is designed to get rid of individual legal agreements between health information networks (HINs) and improve the data sharing between those networks. The government can’t require anyone to adopt TEFCA, but HHS is hoping for enough voluntary use of the agreement to create a nationwide interoperability network.
The U.S. Department of Justice (DOJ) also released a request for public input on “ways to modernize federal merger guidelines to better detect and prevent illegal, anti-competitive deals.” It is likely that the mergers that will be under the DOJ’s microscope will include those that involve healthcare insurance companies and hospitals.
Actually, the number of hospital consolidations was down in 2021, but the size of the transactions was up. Eight of the 49 transactions last year were “mega mergers” in which the hospitals involved had average revenues of over $1 billion.
Programming Note: Listen to Matthew Albright’s live reports on federal legislation Mondays on Monitor Mondays 10 Eastern, sponsored by Zelis.
There are varying opinions about the most effective way to get information from someone in an interview. Any TV viewer is aware of good cop/bad
In just days, the U.S. Department of Health and Human Services (HHS) may begin eliminating regulations it deems unlawful or beyond its authority – that
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
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
