Inpatient Only List

CMS IPO 2024

Case Study: IPO List Proves Critical in Overturning Denied Inpatient Stay

Case Study, Denial Management, Inpatient Only List, Medicare / By

CLINICAL SUMMARY: Doctors performed a scheduled hysteroscopy with dilation and curettage (D&C), endocervical myomectomy and MyoSure polypectomy on a 55-year-old patient who had been experiencing abnormal uterine bleeding with cervical fibroids and an endometrial polyp. The patient had a medical history which included pancreatitis due to alcoholism with a pseudocyst, deep venous thrombosis, hypertension, pleural […]

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Physicians in operating room

Case Study: TKA Inpatient Status Denied Despite Being on CMS Inpatient Only List

Case Study, Denial Management, Inpatient Only List / By

Insurance companies are more likely to approve inpatient status for surgeries included on the CMS Inpatient Only List (IPO). Total knee replacements and total hip replacements are two common procedures on the IPO list. A Peer-to-Peer review can help reverse a denial for a inpatient stay for these types of cases. CLINICAL SUMMARY: TKA Inpatient

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Doctors in surgery, CMS to keep inpatient only list

CMS to Keep the Inpatient Only List

Blog, Inpatient Only List, Length of Stay, Medicare / By

The Centers for Medicare and Medicaid Services’ decision to not eliminate the inpatient only list (IPO) was due to the numerous comments and feedback it received from the medical community, the COVID-19 public health emergency and the fact that the change “transpired quickly,” according to the final rule (CMS-1753FC) issued in December.1 Heading into 2022,

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Administrative law judge reviews appeals at the highest level

Appealing Denials through the Medicare Claims Appeals Process Works

Blog, Inpatient Only List, Length of Stay, Medicare / By

Though it took time and effort, an administrative law judge ruled in favor of a client hospital and overturned a Medicare claim denial for a total knee replacement surgery. The hospital can now fully recover the cost of that surgery, with interest. The case dates back to 2015 when a traditional Medicare patient underwent a

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doctors in surgery

Eliminating the CMS IPO List will Continue to Complicate Hospital Stays

Blog, Inpatient Only List, Utilization Review / By

For an update on this issue, please read: CMS reverses course in inpatient only list   The Centers for Medicare & Medicaid Services (CMS) has begun to dismantle its inpatient only list, which has directed the level of care for more than 1700 procedures for physicians and hospitals since 2000. CMS said the move gives physicians

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