ICD10monitor January 3, 2024
Back in 2010, a class-action lawsuit was filed by a group of Medicare beneficiaries who had to pay out of pocket for their stays at a skilled nursing facility (SNF) for rehabilitation after an illness – because their hospital stays, all of which exceeded three days, were outpatient Part B stays.
For those who were involved in utilization review (UR) in 2010, you probably recall that it was the heyday of the Recovery Audit Contractor (RAC) program. The RACs, paid on a contingency basis, saw inpatient admissions as easy prey for denial. The rules governing inpatient admission were vague, and many hospitals did not have the resources to fight back. In addition, the Centers for Medicare & Medicaid Services (CMS)...
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