September 2024

PA secondary reviews raise reimbursement

Case Study: Physician Advisor Secondary Review Insight on MA Case

CLINICAL SUMMARY: An 88-year-old patient with a complex cardiac history of chronic congestive heart failure and dilated cardiomyopathy arrived at the emergency department (ED) with worsening shortness of breath and intermittent dizziness. The patient’s medical history included COPD, dilated cardiomyopathy, ventricular tachycardia with implantable cardioverter-defibrillator (ICD) shocks, atrial fibrillation (for which the patient uses Eliquis®), […]

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Hospitals should file a complaint when the Medicare Advantage (MA) plans do not follow the Two-Midnight rule

Hospitals should file a complaint when the Medicare Advantage (MA) plans do not follow the Two-Midnight rule

An American College of Physician Advisors’ (ACPA) recent report concurs with earlier data from AppriseMD that many Medicare Advantage Organizations (MAOs) are not complying with the guidelines that the Centers for Medicare and Medicaid Services established under rule 4201-F. In its News to Note from July 20241, the ACPA looked at whether all of the

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