Think like CMS: Ensure your facility is prepared for the newest rules and regulations

Wednesday, June 1, 2022

Editor’s note: Marc Hartstein, MA, principal at Health Policy Alternatives, will present “Rules Round Robin: IPPS, OPPS, and MPFS” on Day 1 of the Revenue Integrity Symposium, which takes place on September 19-20 at the Hilton Phoenix Resort at the Peak in Phoenix, Arizona. Hartstein came to Health Policy Alternatives in Washington, D.C., after 26 years with CMS. He held several management and staff positions during his time at CMS, most recently as the director of the Hospital and Ambulatory Policy Group. At CMS, Hartstein was central to the development of MS-DRGs, the 2-midnight rule, Medicare’s policy for off-campus hospital outpatient departments, the misvalued code initiative, and regulations to implement Medicare’s new clinical laboratory fee schedule, among other policies.

NAHRI: In what ways does your session challenge revenue integrity professionals to think outside the box?

Hartstein: This session will be delivered by three experts on CMS’ Medicare rules and regulations, one of whom has more than 27 years of service at CMS, including several as a senior executive. This session will help the audience think like CMS does, which may not always be the most logical and consistent with how those outside the government think.

NAHRI: What piece of advice do you like to give people about revenue integrity?

Hartstein: Bill consistent with the rules and regulations, and do not be afraid to bill for services accordingly and maintain detailed documentation to support your billings.

NAHRI: What’s one of the most important pieces of information you would like people to take away from your session?

Hartstein: I would like attendees to take away a comprehensive and complete understanding of Medicare’s latest inpatient and outpatient hospital payment rules that are constantly changing.