America’s new normal.
Unemployed, uninsured, unbelievable! The U.S. Bureau of Labor Statistics indicates that 12.6 million Americans are on unemployment rosters around the country; 32.5 percent of the adult population has been jobless for over five months. Of those who are jobless, many remain uninsured. What happens when these individuals are infected with COVID? The answer is simple: the federal government is supposed to cover testing and treatment.
States with the highest uninsured rates are receiving the majority of dollars. How much are we talking about? How does $1.5 billion sound? That’s a pretty penny, though lower than many experts anticipated. QuoteWizard by Lending Tree evaluated data from the U.S. Centers for Disease Control and Prevention (CDC) on claims reimbursement to providers over the course of the pandemic. The study looked at the total funds provided to each state through uninsured claims for testing and treatment. That figure was then divided by the total number of COVID-19 cases for the state, as well as those who are uninsured. Keep in mind that on top of 12.6 million unemployed in the U.S., there are well over ten million cases of the virus, with over 50,000 hospitalizations at present.
States with the highest numbers of uninsured people were among those that received the most funding in COVID-19 reimbursement – in other words, the highest costs per case were associated with states with the highest levels of uninsured individuals. Ten of these states were non-Medicaid expansion states (specifically Texas, North and South Carolina, Georgia, Florida, Tennessee, Kansas, Mississippi, Alabama, and South Dakota). New Jersey sat atop the list, followed by North Carolina, Texas, and Tennessee. While the average cost per case was $142, the rate variation between New Jersey and Tennessee was fascinating:
The URL for the list of all states appears on the QuoteWizard site.
I’m unsure what’s more intriguing about these numbers: the variations in treatment and costs per case, or considering how much higher these costs will get? Economic relief packages passed by Congress allocated $176 billion towards reimbursement for hospitals and healthcare facilities.
With the latest COVID wave hitting states with the highest numbers of persons impacted most by the social determinants of health (SDoH), this week’s Monitor Mondays Listeners Survey asked whether there will be sufficient reimbursement by the federal government to pay all submitted claims. The answers may surprise you, and can be viewed here.
Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10 a.m. EST.
I receive a lot of newsletters every morning to help me stay abreast of what is happening in the healthcare industry. A troubling recent trend
EDITOR’S NOTE Day 3 of the federal shutdown continues. This article by Mark Spivey is part of a special section today published by RACmonitor and
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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.
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.
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.
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.
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.
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.
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