Healthcare Information Research

A Collection of Case Studies, Position Papers and White Papers from AppriseMD


Outpatient Arthroplasty Surgery: A Position Paper from AppriseMD

The American Association of Hip and Knee Surgeons have stated that hip and knee replacements can be safely performed in the outpatient setting in some specific circumstances. However, the wording implies the procedure is most appropriate in an ideal patient when performed in a facility and by a surgical team specifically equipped for this type of procedure.  The clear implication is that an outpatient procedure should not be a viewed as an appropriate or mandatory setting for arthroplasty procedures.

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CASE STUDY: Can Peer-to-Peer Reviews Overturn Short Hospital Stay Inpatient Denials?

Inpatient admissions less than two days in length which have been denied by a commercial carrier are appropriate for Peer-to-Peer Review, but not all hospitals and doctors have the time or the will to do these reviews. Once we have moved past the extreme situation of the COVID-19 pandemic, hospitals are going to look hard at finding any way they can recoup dollars. We have done a limited study and seen the benefit of P2P reviews at AppriseMD and how it can reverse denials and recoup dollars for hospitals.

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AppriseMD Blog

Utilization Review: In-house or Outsource?

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Utilization management programs are often in-house services provided by hospital staff. However, more and more hospitals are outsourcing utilization review management as the pressure mounts to contain costs, especially following the COVID-19 pandemic, and improve care. Hospitals benefit from outsourcing utilization review in several ways, as it can: Free up in-house physician advisors and chief […]

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Documentation – A Key for Reduced Denials

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There is one relatively easy way hospitals can reduce claims denials: better clinical documentation. Insurance companies require documentation, and it is often the leading factor in level of care and admission denials. The importance of providing complete documentation never goes away. Treating physicians and utilization review managers must ensure that every admission includes: All the […]

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A quiet shift that could shake up hospital Utilization Review

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There is a seismic shift happening in Utilization Review: As of Saturday, May 1, 2021, UnitedHealthcare, the country’s largest healthcare insurance provider, is changing guidelines to adjudicate the level of care cases for hospitals from Milliman Care Guidelines (MCG) to InterQual.1 AppriseMD will be working closely with our current hospital clients to ensure this is […]

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Utilization Review Managment can help hospitals with COVID revenue loss

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Recouping revenue lost to COVID

COVID-19 continues to have detrimental effects not only on health of people, but also on the economy and businesses in general. Included in these businesses are hospitals which have been expected to be fully supplied, staffed and ready to provide cutting edge care throughout the pandemic.  According to a new report released in February from […]

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Providing the best outcome for patients through UR

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“The Hippocratic Oath is one of the oldest binding documents in history. Written in antiquity, its principles are held sacred by doctors to this day: treat the sick to the best of one’s ability, preserve patient privacy, teach the secrets of medicine to the next generation…” 1 As a physician-owned company in which board-certified physicians carry out […]

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The Slow Return

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  In the Chicago area, when it seems like the most challenging aspects of the pandemic seem to be behind us, the roller coaster rise and fall in cases of the pandemic continue. While hospitals are struggling to rebound from the economic impact of the pandemic, they are also looking at opportunities. Administrators may have […]

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