June 2024

Patient being treated in the hospital

Case Study: Denial Reversed in Short Stay Alcohol-Induced Pancreatitis Admission

Case Study, Denial Management / By

CLINICAL SUMMARY: A 30-year-old patient arrived at the emergency room suffering from abdominal pain, nausea and vomiting. The patient’s symptoms had been occurring for the past six weeks and progressively worsened. The patient complained of pain in the upper abdomen that radiated to the back. The patient had a medical history of anxiety, asthma, depression, […]

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Compliance with CMS 4201-F pie chart

Medicare Advantage Organization Non-Compliance with The Two-Midnight Rule Findings

Blog, CMS, Medicare Advantage, Two-Midnight Rule / By

AppriseMD hospital utilization review data for the first two months of 2024 shows that Medicare Advantage Organizations (MAOs) are denying claims that would have been approved under Traditional Medicare. BACKGROUND MAOs must adhere to the same guidelines as Traditional Medicare as per the Center for Medicare and Medicaid Services’ (CMS) 2024 rule 4201-F. MAOs can

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