EDITOR’S NOTE:
For newer readers who might be wondering what the heck those are, back in 2015, when Dr. Ronald Hirsch didn’t have a topic for his Monitor Mondays segment, and it was near the end of the year, he decided to acknowledge a few people whose actions stood out to him. And the rest is history, although Hirsch laments that he has yet to find a corporate sponsor who would lavish each year’s heroes with gifts. Below is a transcript of his segment this morning on Monitor Mondays.
Now, before I announce this year’s recipients, let me remind you all that starting Jan. 1, the Medicare Advantage (MA) plans are required to follow the Two-Midnight Rule. We are all speculating that this will not go well, but I am going to give them the benefit of the doubt and hope that they have spent the last few months preparing to be law-abiding organizations.
If there will be problems, I suspect that the most problems will come with the MA plans determining when the patient’s care began in the hospital, to start the two-midnight counting. They are not used to looking for that first EKG or CBC, but instead focus on the admission status order. So be ready to educate them.
Now, on to the heroes for 2023.
First up is a dynamic duo of revenue cycle experts: Jugna Shah and Valerie Rinkle. I first met them when we were all appointed to the Advisory Board of the National Association of Healthcare Revenue Integrity, and it became immediately apparent that they were both amazingly knowledgeable about the entire revenue cycle: an area where I had a lot of learning to do.
Through the years I had the opportunity to learn from both of them, both at conferences and with personal communications. I know that if I have a question, I can ask either of them and get a rapid, accurate response. In fact, I have mentioned Jugna here before, discussing the unique payment issues surrounding CAR-T therapy. I also collaborated with Valerie on an article about billing for custodial care. And the three of us did a joint presentation at the most recent NAHRI conference. For their expertise and friendship, I name them Hirsch’s Heroes.
My next hero is someone we all know: David Glaser. From the day I started doing Monitor Mondays in 2012, David has been there. I could summarize all he does for all of us, but if you are a listener, you already know. As many of you also know, David is also a weather nerd, as is my son, so I respect him for that, although I wonder about his judgment when he goes storm chasing. David also freely shares his knowledge with webinars for RACmonitor and through his own law firm.
And David is a great source for good books and movies to help me with my work-life balance. For his many contributions, I named him a Hirsch’s Hero.
And my last hero is Dr. Eugene Freund. If you have attended a recent Centers for Medicare & Medicaid Services (CMS) Open Door Forum, you have likely heard Dr. Freund moderate a call. Dr. Freund is officially a medical officer with the CMS Office of Communications, but he really is a family physician who has transitioned from clinical practice into the regulatory world, and he keeps that clinical perspective as he works with providers. He also conducts periodic calls aimed at providers to keep them informed of recent regulatory changes and answer questions, many of which come from me. And if he doesn’t have an answer, he makes it his job to get an answer. I respect all the staff at CMS, but Dr. Freund stands out as a shining star and for that, I name him a Hirsch’s Hero.
Finally, since Chuck gave me a bit of extra space, I have to note that Livanta has released a response to the controversy over their July short-stay document where they clarify what they really meant when they said that all emergent cholecystectomies could be inpatient. Do read it – it is what they should have said the first time.
Thanks, Chuck, and thanks to all of you for reading.
The Centers for Medicare & Medicaid Services (CMS) continues to expand its focus on hospital readmissions in the FY 2027 IPPS (Inpatient Prospective Payment System)
With the April 1 update, the Centers for Medicare and Medicaid Services (CMS) implemented 80 new PCS codes. To break it down, there are 24
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