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AppriseMD Blog
Medical necessity often requires nuanced interpretations based on an individual’s medical history that considers appropriate, reasonable and necessary healthcare interventions. While insurance companies typically utilize a finite criterion that meets medical necessity, physician advisors are indispensable for safeguarding reimbursement to ensure that healthcare organizations can continue providing quality care. Continue reading to see how AppriseMD […]
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 Many hospitals and health systems have been forced to navigate a new payer tactic that does not result in a formal denial of inpatient (IP) level of care (LOC). Instead, the payer affirms that IP admission was medically necessary, but reimbursement is reduced due to a perceived lack of severity for the billed […]