Denials Going from Bad to Worse

Denials in healthcare are a problem. Recently, though, the problem seems to be getting worse, especially with the misapplication of the Two-Midnight Rule by Medicare Advantage (MA) plans, according to Nick Hut, senior editor for Healthcare Financial Management Association (HFMA). Hut reports that MA plans are classifying hospital stays as outpatient observation visits at a significantly higher rate than traditional Medicare even though the rule is supposed to be applied the same way in both programs. And Hut believes the situation is likely to be getting worse because UnitedHealthcare is targeting provider coding while it seeks to bring down medical spending that has been higher than anticipated in recent fiscal quarters. Hut will be reporting this story during the next live edition of Monitor Mondays. He has more than 12 years reporting healthcare policy news and trends. Other segments during the weekly broadcast will include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Legislative Update: Adam Brenman, senior legislative affairs analyst for Zelis, will report on current healthcare legislation. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.