Audit News Exacerbates Healthcare Crisis

by  Ronald Hirsch, MD FACP CHCQM CHRI
Mar 24th, 2022

No good news is not good news.

Last week brought some news that may have significant financial consequences for many providers. The Health Resources and Services Administration (HRSA) program that funded care for uninsured patients with COVID-19 will run out of money and stop accepting claims on March 22.

While numbers are down substantially, COVID is not gone. As of March 15, there were over 20,000 people hospitalized nationwide, and cases of the new variant are rising. We can hope that hospital numbers continue to decline but should also hope that Congress adds more funds to the program, so providers do not have to start sending bills to patients without coverage. This fund also pays for vaccines, and if it is determined that more boosters are needed, the lack of funds is sure to have serious consequences.

Next, UnitedHealthcare (UHC) recently released a notice for gastroenterologists who are participating providers with Oxford New York. The subhead of the notice went on to state that “Oxford New York gastroenterologists are required to use Oxford participating anesthesiologists.”

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Read the entire article at RACmonitor by clicking here.

This article originally published on March 23, 2022 by RACmonitor.

About Ronald Hirsch, MD FACP CHCQM CHRI

Ronald Hirsch, MD, is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, and the National Association of Healthcare Revenue Integrity, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays. The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).