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  • CMS Documentation Changes are Here

    | Performance, Policy

    The last time documentation requirements to support clinician billing changed was 1997. I was an intern then at Allegheny General Hospital in Pittsburgh, and I […]

  • Telehealth. Is. Health.

    | Policy, Telemedicine

    #TelehealthIsHealth Just ask the 14,000+ patients Sound’s tele-physicians treat every month – in the ICU, inpatient wards, skilled nursing facilities, and at home. As Chief […]

  • DRG Downgrades: Prevent and Dispute Payer Revisions

    | Performance, Policy

    Commercial and public payers are estimated to deny about one in every ten submitted claims, costing health systems up to 2% of net patient revenue […]

  • Mandatory Bundled Payments – Are you Ready?

    | Policy, Thought Leadership

    Read the whitepaper here: Instant download CMS introduced bundled payment models over the past decade, including the current BPCI-A program, which has effectively reigned in […]

  • Tactics to Successfully Appeal a Denial Letter

    | Performance, Policy

    When creating an appeal letter, clarity and brevity are essential to increasing success. Now more than ever, overturning denials is critical for hospitals’ revenue cycles. […]

  • What You Need to Know (And Do) About the Inpatient Only List

    | Policy

    It’s back! For more than 20 years, the Inpatient Only list (IPO) ruled as CMS’ method of determining how they would pay for surgeries under […]

  • Aligning Physicians to Value – Show, Don’t Tell!

    | Clinical Innovation, Policy, Thought Leadership

    Value-based care (VBC) is advancing, but for many, the transition from fee-for-service proves challenging. As noted earlier this year in the HealthLeaders 2021 Value-Based Care […]

  • Sound Physicians Industry Report Explores Rising Risks to Appropriate Hospital Reimbursement

    | Policy

    Sound Physicians’ nationwide survey provides insights into the barriers hospital case managers, utilization review teams, physician advisors, and hospital executives face in achieving their goals […]

  • Shedding Light on “Observation”

    | Policy

    Once Medicare began paying by the diagnosis, it didn’t take long for payers to question proper DRG payments. Out of this, the observation stay was born.

  • The Opioid Crisis

    | Policy

    We are in the throes of the prescription opioid crisis. To understand how to solve the issue of opioid addiction, we must look to the cause of the crisis and identify additional methods for managing pain.

  • Total Knee Arthroplasties

    | Policy

    When CMS removed Total Knee Arthroplasties (TKA) from the “inpatient only” list, it created confusion for providers. I’m discussing the issues surrounding TKA and how you can use the Two-Midnight Rule as your guide.

  • Proud, Grateful, and Inspired

    | Policy

    I recently received an invitation from the White House to meet with senior officials and ten other healthcare executives to discuss the challenges of electronic health record system interoperability. Read about my experience here.

  • Two-Midnight Rule: Is It Keeping You up at Night?

    | Policy

    It has been almost four years since CMS adopted the Two-Midnight Rule, yet it continues to be a source of confusion and ambiguity for providers. Simon Ahtaridis, MD, National Clinical Advisor and CMO, discusses what you need to know about the Two-Midnight Rule.

  • Seek First to Understand

    | Policy

    I travel a lot for work. The trick is to find a way to weave your interests into the travel. Some like to run and […]