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CLINICAL SUMMARY: A 29-year-old male patient with no significant past medical history arrived at the Emergency Department with ongoing abdominal pain, cramping and tenderness in the left upper quadrant and epigastric region. This patient presented with a weight of 523 pounds, a BMI of 87 and labs as follows: WBC 12.07, ANC 9.34, Hgb 13.4, […]
White Papers
The financial impact of the IPO list magnified with the rise of CMS-4201-F, giving rise to inpatient reimbursement for all MAO patients who require services designated on the IPO list. Hospitals need to ensure that the proper setting is scheduled when any Medicare or MA patient undergoes a procedure designated on the IPO list, and they should also follow any proposed additions and removals to the list closely to ensure appropriate treatment and reimbursement.
Case Studies
THE CHALLENGE Hospitals continue to face payer denials throughout the revenue cycle, including technical and administrative denials, as well as coding denials where Diagnostic Related Group (DRG) downgrades are a major pain point. Clinical denials are also rampant, whereby the payers are challenging the clinical judgement of providers despite clear evidence that, for example, inpatient […]