November 2024 Newsletter Highlights
A Note From Natalie
November marks the beginning of a busy holiday season with Thanksgiving on November 28 topping the list.
It’s also Native American Heritage Month. However, there are many other important dates throughout the month as well. For example, we have an opportunity to honor all those who serve in the United States armed forces on Veteran’s Day (November 11). November 13 is World Kindness Day, and there’s no better reason to perform random acts of kindness and help others. Also don’t forget World Diabetes Day (November 14). Think about ways to celebrate these and other important dates in your revenue cycle management department. And always focus on revenue integrity and compliance. QualCode can help.
Natalie Williams ~ President & CEO
Observation rates for MA beneficiaries in 2024 remain elevated
The specifics: Medicare Advantage plans classified three to four times as many hospital stays as observation visits from July 2023 through the end of June 2024 when compared with traditional Medicare, according to a recent report. This is even despite a federal regulation that went into effect in January requiring Medicare Advantage plans to cover the same services as traditional Medicare.
What’s next: Determine whether any of the Medicare Advantage plans with which your organization participates follow the same trend. If so, there could be significant financial implications. Claim audits may help uncover this information.
BCBS agrees to pay $2.8 billion to resolve antitrust class action claims
The specifics: Blue Cross Blue Shield (BCBS) recently agreed to pay $2.8 billion to resolve antitrust class action claims regarding dividing markets and fixing prices. Plaintiffs originally filed the lawsuit in 2012, and the settlement covers U.S. healthcare service providers, including hospitals and some doctors, with Blue plan patients between July 2008 and October 2024.
What’s next: The agreement is subject to approval from U.S. District Judge R. David Proctor. Court is expected to review the Motion for Preliminary Approval in November, and formal notice will be sent to all class members at a later date determined by the Court.
New CMS rule gives patients appeal rights when their hospital status changes
The specifics: According to a new CMS final rule, eligible Medicare beneficiaries may be able to appeal a denial of their Part A coverage when a hospital reclassifies them from inpatient to outpatient status at some point during their hospital stay.
What’s next: Know how this rule may affect your healthcare organization. This article provides more information about what the rule means for hospitals, including what to do in the event of a successful appeal and how to notify Medicare beneficiaries of their changes in status.