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AppriseMD Blog
An inpatient level of care (LOC), initially denied by a Medicare Advantage payer, was approved after a peer-to-peer discussion involving a stable patient with a complex medical history and condition that required a transfer to a higher LOC. The short stay exemplifies the importance of having physicians with both payer and clinical experience facilitate the […]
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 LA recent report identified prior authorization request denials by Medicare Advantage Organizations (MAOs) for post-acute care to be a particular area of concern. The report, published by the Department of Health and Human Services Office of Inspector General (HHS-OIG), raised concerns that the MAOs may be inappropriately denying care, evidenced by the 95% […]